=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427805795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHADWICK ELMEN STILL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2024
-----------------------------------------------------
Last Update Date | 05/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5283 SR 7 SOUTH
-----------------------------------------------------
City | GALLIPOLIS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-853-3147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5283 STATE ROUTE 7 S
-----------------------------------------------------
City | GALLIPOLIS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45631-8923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-853-3147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------