Basic Information
| Provider Information | |||||||||
| NPI: | 1134491376 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHAD MCCREARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 N LOCK AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412301115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066384595 | ||||||||
| FaxNumber: | 6066389471 | ||||||||
| Practice Location | |||||||||
| Address1: | 412 N LOCK AVE | ||||||||
| Address2: | |||||||||
| City: | LOUISA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412301115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066384595 | ||||||||
| FaxNumber: | 6066389471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2012 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | MCCREARY | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6066384595 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02962 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.