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General NPI Number Information
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NPI Number | 1134491376
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Entity Type | Organization
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Legal Business Name | CHAD MCCREARY
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 412 N LOCK AVE
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City | LOUISA
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State | KY
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Zip | 41230-1115
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Country | US
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Telephone | 606-638-4595
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Fax | 606-638-9471
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Provider Business Mailing Address
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Address Line | 412 N LOCK AVE
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City | LOUISA
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State | KY
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Zip | 41230-1115
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Country | US
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Telephone | 606-638-4595
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Fax | 606-638-9471
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD MCCREARY
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Credential | DO
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Telephone | 606-638-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02962
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License Number State | KY
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