Provider Demographics
NPI:1194422253
Name:CH SPECIALTY SERVICES MO LLC
Entity type:Organization
Organization Name:CH SPECIALTY SERVICES MO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-408-0797
Mailing Address - Street 1:5750 JOHNSTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5334
Mailing Address - Country:US
Mailing Address - Phone:337-408-0797
Mailing Address - Fax:337-943-0846
Practice Address - Street 1:400 SW LONGVIEW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2116
Practice Address - Country:US
Practice Address - Phone:337-408-0797
Practice Address - Fax:337-943-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty