MEDICARE: MR. CHAD S PRIEST RN

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	163WG0000X	General Practice Registered Nurse	28145096A	IN

General Provider Information

NPI Number	:	1386813251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD S PRIEST RN

Provider Business Mailing Address
First Line	:	300 N MERIDIAN ST
Second Line	:	SUITE 2700
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1755
Country	:	US
Telephone Number	:	317-237-1349
Fax Number	:	317-237-1000

Provider Business Practice Location Address
First Line	:	300 N MERIDIAN ST
Second Line	:	SUITE 2700
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1755
Country	:	US
Telephone Number	:	317-237-1349
Fax Number	:	317-237-1000

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

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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