Provider Demographics
NPI:1316150469
Name:JOHN B CHACE MD PC
Entity type:Organization
Organization Name:JOHN B CHACE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:CHACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-329-4102
Mailing Address - Street 1:500 EAST ROBINSON
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6771
Mailing Address - Country:US
Mailing Address - Phone:405-329-4102
Mailing Address - Fax:405-364-3476
Practice Address - Street 1:500 EAST ROBINSON
Practice Address - Street 2:SUITE 2300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6771
Practice Address - Country:US
Practice Address - Phone:405-329-4102
Practice Address - Fax:405-364-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24274208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00397767OtherMEDICARE RAILROAD
OK200060960BMedicaid
OK200060960AMedicaid
OKOK100076Medicare PIN
OKP00397767OtherMEDICARE RAILROAD
Y39060Medicare UPIN
OK200060960AMedicaid
OK249730604Medicare PIN