Chad E Davis, NP
Individual provider Active NPI Nurse Practitioner · Logansport, IN
NPI 1104081702 · NPPES record last updated Sep 15, 2008
Key facts
- NPI
- 1104081702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71002747A (IN)
- Practice address
- 1098 S State Road 25
Logansport, IN 46947-6723 - Phone
- (574) 722-4141
- Fax
- (574) 735-3414
- NPI assigned
- Jul 23, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120524000040 | IN | Practitioner - Nurse Practitioner | 8527221894 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Indiana, Auditor of State | Current |
Accepting new patients | |
| State of Indiana, Auditor of State | Current | Accepting new patients | |
| State of Indiana, Auditor of State | Current |
Accepting new patients | |
| State of Indiana Auditor of State | Past | Accepting new patients |
Locations
1098 S State Road 25
Logansport, IN 46947
Phone (574) 722-4141
3851 N River Rd
Ofc
West Lafayette, IN 47906
3851 N River Rd
West Lafayette, IN 47906
Phone (765) 463-1502
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71002747A | IN | Yes |
Addresses
Primary practice location
1098 S State Road 25
Logansport, IN 46947-6723
Mailing address
1098 S State Road 25
Logansport, IN 46947-6723
Phone (574) 722-4141
Other providers in Logansport, IN
- Jessica Crume
- Glorisel Cruz Velez
- Rafael Cruz
- Kayci Cunningham
- Curtis Kesling
- James R Davis
- Levi Randall Davis Jr.
- Monica Davis
- Jill L Day
- Hope Decker
All providers in Logansport, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.