Nchang Mantoh Azefor, M.D.
Individual provider Active NPI Surgery Physician · Liberal, KS
NPI 1336375104 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1336375104
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 0440303 (KS)
- Practice address
- 305 W 15TH St Ste 204
Liberal, KS 67901 - Phone
- (620) 624-4946
- Fax
- (620) 624-2260
- NPI assigned
- Jun 6, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Howard University College of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fauquier Physician Practices LLC
Practice addresses (Care Compare)
1100 Sunset LN
Suite 1211a
Culpeper, VA 22701-3375
Phone (540) 812-2937
500 Hospital Dr
Warrenton, VA 20186-3027
Phone (540) 316-4360
550 Hospital Dr
Warrenton, VA 20186-3027
Phone (540) 316-5940
7915 Lake Manassas Dr
Suite 101
Gainesville, VA 20155-3259
Phone (703) 743-7300
9001 Digges Rd
Suite 208
Manassas, VA 20110-4414
Phone (703) 743-7370
Hospital & facility affiliations
- Fauquier Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Hernia repair (minimally invasive) | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211119002162 | VA | Practitioner - General Practice | 4587921549 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fauquier Physician Practices LLC | Surgery | Current |
Accepting new patients |
| Wythe County Physician Practices LLC | Surgery | Current |
Accepting new patients |
| Wythe County Physician Practices LLC | Past | Accepting new patients |
Locations
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
1100 Sunset Ln
Ste 1201A
Culpeper, VA 22701
Phone (540) 812-2937
1100 Sunset Ln
Ste 1211A
Culpeper, VA 22701
Phone (540) 825-2900
7915 Lake Manassas Dr
Ste 101
Gainesville, VA 20155
Phone (703) 743-7300
9001 Digges Rd
Ste 208
Manassas, VA 20110
Phone (703) 526-0666
550 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5940
500 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5000
600 W Ridge Rd
Wytheville, VA 24382
Phone (276) 228-0200
590 W Ridge Rd
Ste A
Wytheville, VA 24382
Phone (276) 228-7948
Interoperability endpoints
- azefnch@directswmedcenter.com
- nchang.azefor.1@16767.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 0440303 | KS | Yes |
Addresses
Primary practice location
305 W 15TH St Ste 204
Liberal, KS 67901
Mailing address
PO Box 1215
Liberal, KS 67905-1215
Phone (620) 629-3338
Other practice location 1
110 Irving St NW
Washington, DC 20010-3017
Phone (202) 877-7227
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200741890A | Medicaid | OK | |
| 201174830A | Medicaid | KS |
Other providers in Liberal, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2018. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.