Provider Demographics
NPI:1902945421
Name:J SCOTT CHENNAULT, D.O.
Entity type:Organization
Organization Name:J SCOTT CHENNAULT, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHENNAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:979-567-7080
Mailing Address - Street 1:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-6154
Mailing Address - Country:US
Mailing Address - Phone:979-567-7080
Mailing Address - Fax:
Practice Address - Street 1:1103 WOODSON DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1052
Practice Address - Country:US
Practice Address - Phone:979-567-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113320OtherCHIP
TX00D79EOtherBLUE CROSS BLUE SHIELD TX
TX113320OtherCHIP