Provider Demographics
NPI:1427120187
Name:SUNIL G & NILIMA P CHAND
Entity type:Organization
Organization Name:SUNIL G & NILIMA P CHAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:GUPTA
Authorized Official - Last Name:CHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-756-7880
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0107
Mailing Address - Country:US
Mailing Address - Phone:573-756-7880
Mailing Address - Fax:573-756-2669
Practice Address - Street 1:1031 E KARSCH BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3404
Practice Address - Country:US
Practice Address - Phone:573-756-7880
Practice Address - Fax:573-756-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109268261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI1852OtherRAILROAD MEDICARE
MO505183608Medicaid
MO590121307Medicaid
CI1852OtherRAILROAD MEDICARE
MO590121307Medicaid
MO268945Medicare ID - Type UnspecifiedRIVERBEND GBA
MO505183608Medicaid