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NPI Code Detail

MEDICARE: DR. CHAD R NILES MD

MEDICARE: DR. CHAD R NILES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianL0882TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28V5498OTHERTXBCBS TC RADIOLOGY

General Provider Information

NPI Number : 1073587788
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD R NILES MD
Provider Business Mailing Address
First Line : PO BOX 847522
Second Line :
City : DALLAS
State : TX
Zip : 75284-7522
Country : US
Telephone Number : 903-531-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2026 S JACKSON ST
Second Line :
City : JACKSONVILLE
State : TX
Zip : 75766-5822
Country : US
Telephone Number : 903-541-4500
Fax Number : 903-541-0791
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 12/05/2025

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