MEDICARE: CHESTNUT HEALTH OF MISSOURI LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1659195345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTNUT HEALTH OF MISSOURI LLC

Provider Business Mailing Address
First Line	:	1530 N RANDALL RD STE 210
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-7879
Country	:	US
Telephone Number	:	703-348-6060
Fax Number	:	703-649-6188

Provider Business Practice Location Address
First Line	:	13700 OLD HALLS FERRY RD
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-4109
Country	:	US
Telephone Number	:	314-355-0760
Fax Number	:	703-649-6188

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JAI KUMAR
Credential	:
Telephone Number	:	703-348-6060

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

Similar Medicare Providers

1689347627 — MR. SCOTT MARCHINO MPT
Practice Location Address:

13700 OLD HALLS FERRY RD
BLACK JACK, MO
63033-4109

Practice Phone: 314-355-0760
Practice Fax:

1538046081 — AMERIWOUND PHYSICIANS MO LLC
Practice Location Address:

13700 OLD HALLS FERRY RD
BLACK JACK, MO
63033-4109

Practice Phone: 314-355-0760
Practice Fax:

1548258023 — HELIA HEALTHCARE OF FLORISSANT, LLC
Practice Location Address:

13700 OLD HALLS FERRY RD
FLORISSANT, MO
63033-4109

Practice Phone: 314-355-0760
Practice Fax: 314-355-8169

1093977092 — SIMCHAH CARE, LLC
Practice Location Address:

8601 N BLACK CANYON HWY , SUITE 208
PHOENIX, AZ
85021-4109

Practice Phone: 602-595-1539
Practice Fax: 602-513-7216

1336706944 — KATHRYN MCCLEARN LPC
Practice Location Address:

8601 N BLACK CANYON HWY STE 103OFC10
PHOENIX, AZ
85021-4109

Practice Phone: 602-845-0707
Practice Fax: 602-296-0398

1457918526 — GROWTH SPACE, PLLC
Practice Location Address:

8601 N BLACK CANYON HWY STE 103OFC10
PHOENIX, AZ
85021-4109

Practice Phone: 602-845-0707
Practice Fax: 602-296-0398

Directions to “CHESTNUT HEALTH OF MISSOURI LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.