Provider Demographics
NPI:1487121117
Name:CHANCELLOR MEDICAL
Entity type:Organization
Organization Name:CHANCELLOR MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEM MGR.
Authorized Official - Prefix:
Authorized Official - First Name:DENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-723-3037
Mailing Address - Street 1:1224 N FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:561-723-3037
Mailing Address - Fax:
Practice Address - Street 1:1224 N. FEDERAL HIGHWAY
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:561-723-3037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies