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NPI Code Detail

MEDICARE: DR. SIDNEY BOYD CHADWELL JR. D.O.

MEDICARE: DR. SIDNEY BOYD CHADWELL JR. D.O.
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
1207Q00000XFamily Medicine PhysicianG4452TX

Other Identifiers

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

General Provider Information

NPI Number : 1902827801
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SIDNEY BOYD CHADWELL JR. D.O.
Provider Business Mailing Address
First Line : 4201 S LOOP 256
Second Line :
City : PALESTINE
State : TX
Zip : 75801-8476
Country : US
Telephone Number : 903-723-8533
Fax Number : 903-723-5190
Provider Business Practice Location Address
First Line : 4201 S LOOP 256
Second Line :
City : PALESTINE
State : TX
Zip : 75801-8476
Country : US
Telephone Number : 903-723-8533
Fax Number : 903-723-5190
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2006
Last Update Date : 05/29/2012

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