MEDICARE: RANDY CHADWELL PA

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
1	363AS0400X	Surgical Physician Assistant	105209-1206	UT

Other Identifiers

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

General Provider Information

NPI Number	:	1295838605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY CHADWELL PA

Provider Business Mailing Address
First Line	:	2500 CANYON RD STE 1
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-444-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 CANYON RD BLDG B
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-444-1491
Fax Number	:	435-787-1913

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	08/28/2020

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Directions to “ RANDY CHADWELL PA” Practice Location

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