MEDICARE: CHAD VANHILL CCP

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	242T00000X	Perfusionist	089077

General Provider Information

NPI Number	:	1730847005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD VANHILL CCP

Provider Business Mailing Address
First Line	:	2079 E WOODSTONE DR
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-8625
Country	:	US
Telephone Number	:	208-651-6995
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 TROUSDALE DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4506
Country	:	US
Telephone Number	:	650-799-8991
Fax Number	:

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

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	12/03/2021

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