Provider Demographics
NPI:1679743215
Name:CHESTER K DOBSON
Entity type:Organization
Organization Name:CHESTER K DOBSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-343-0674
Mailing Address - Street 1:1138 N GERMANTOWN PKWY
Mailing Address - Street 2:101-277
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5872
Mailing Address - Country:US
Mailing Address - Phone:225-343-0674
Mailing Address - Fax:866-867-7376
Practice Address - Street 1:3875 FLORIDA BLVD
Practice Address - Street 2:B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3840
Practice Address - Country:US
Practice Address - Phone:225-343-0674
Practice Address - Fax:866-867-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5564200001Medicare NSC