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NPI Code Detail

MEDICARE: JEANIE CHAMNESS PA-C

MEDICARE: JEANIE CHAMNESS PA-C
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
1363A00000XPhysician Assistant085002619IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3080137051OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1047016OTHERHEALTH ALLIANCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
410019630OTHERBCBS
5334689OTHERHEALTH LINK

General Provider Information

NPI Number : 1194839126
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANIE CHAMNESS PA-C
Provider Business Mailing Address
First Line : PO BOX 429
Second Line :
City : MC LEANSBORO
State : IL
Zip : 62859-0429
Country : US
Telephone Number : 618-643-2361
Fax Number : 618-643-3917
Provider Business Practice Location Address
First Line : 611 S MARSHALL AVE
Second Line :
City : MC LEANSBORO
State : IL
Zip : 62859-1213
Country : US
Telephone Number : 618-643-2361
Fax Number : 186-433-9176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 03/24/2020

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Directions to “ JEANIE CHAMNESS PA-C” Practice Location

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