CHOTCHAI BOONKHAM MD PC (NPI# 1619248853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619248853 |
| Entity Type | Organization |
| Organization Name | CHOTCHAI BOONKHAM MD PC |
| Practice Address |
3478 Bridgeland Dr Suite 1 Bridgeton MO 63044-2619 |
| Practice Telephone | 3142913717 |
| Practice Fax Number | 3142911671 |
| Mailing Telephone | 3142913717 |
| Mailing Fax Number | 3142911671 |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2012-01-19 |
| Authorized Official Name | DR. CHOTCHAI BOONKHAM (OWNER) |
| Authorized Official Telephone | 3142913717 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
34210 | MO | Ambulatory Health Care Facilities |
| Street Address |
3478 BRIDGELAND DR SUITE 1 |
| City | BRIDGETON |
| State | MO |
| Zip Code | 63044-2619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376647644 | Bruce Jay Berwald | Internal Medicine | 3478 Bridgeland Dr, Bridgeton, MO 63044-2619 | 2006-09-08 |
| 1265742449 | Richar49458751 B Chusak | Plastic Surgery | 3478 Bridgeland Dr, Suite1, Bridgeton, MO 63044-2619 | 2010-10-20 |
| 1609071455 | Michael T Katsev Dds PC | Dentist | 3478 Bridgeland Dr, Suite 3, Bridgeton, MO 63044-2619 | 2007-06-20 |
| 1548345838 | Berwald Surgical Medical Inc | Non-Pharmacy Dispensing Site | 3478 Bridgeland Dr, Ste 2, Bridgeton, MO 63044-2619 | 2006-10-26 |
| 1447334875 | Michael Theodore Katsev | Dentist | 3478 Bridgeland Dr, Bridgeton, MO 63044-2619 | 2006-10-24 |
| 1811084734 | David Morton Berwald | Surgery | 3478 Bridgeland Dr, Bridgeton, MO 63044-2619 | 2006-10-10 |
| 1417058959 | Chotchai Boonkham | Internal Medicine | 3478 Bridgeland Dr, Suite 1, Bridgeton, MO 63044-2619 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073150017 | Zoe Marie Wadsworth | Nurse Practitioner | 12255 Depaul Dr Suite 300, Bridgeton, MO 63044 | 2019-12-10 |
| 1609412451 | Beyond Better, Best Home Health Care Services, Limited Liability Corpo | In Home Supportive Care | 3430 Mckelvey Road Ste B, Bridgeton, MO 63044 | 2019-11-26 |
| 1275189078 | Delicate Angels Home Health LLC | Home Health | 11726 St. Charles Rock Road Suite G, Bridgeton, MO 63044 | 2019-08-16 |
| 1588210082 | Nicholas Huber | Physical Therapist | 12349 Depaul Dr., Ste. 110, Bridgeton, MO 63044 | 2019-08-12 |
| 1124688858 | Michelle Bassett | Registered Nurse | 11520 St. Charles Rock Rd., Suite 106, Bridgeton, MO 63044 | 2019-06-14 |
| 1336703883 | Elena A Barrow | Nurse Practitioner | 12255 Depaul Dr, Suite 260, Bridgeton, MO 63044 | 2019-04-30 |
| 1487123105 | Laura N Steiner | Registered Nurse | Gateway Pediatrics, Ltd, 12255 Depaul Drive, Suite 460 North Medical Building, Bridgeton, MO 63044 | 2018-11-26 |
| 1205310950 | Danielle Mathis | Nurse Practitioner | 3440 Depaul Lane Suite 201, Bridgeton, MO 63044 | 2018-09-19 |
| 1588163570 | Thoughts Out Loud Counseling, LLC | Social Worker | 11520 St. Charles Rock Road Suite 101, Bridgeton, MO 63044 | 2018-02-06 |
| 1912411430 | Breanna Victoria Hayes | Counselor | 3165 Mckevley Road, Suite 200, Bridgeton, MO 63044 | 2017-11-20 |
| Find all providers in zip 63044 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326451782 | Sherrie Colaneriday Npc LLC | Clinic/Center | 700 N Pearl St, Bridgeton, NJ 08302-1208 | 2014-06-03 |
| 1407068851 | Joule N Stevenson Md LLC | Clinic/Center | 12277 De Paul Dr, Suite 406, Bridgeton, MO 63044-2516 | 2007-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145668 | Essential Benefit Offerings, LLC | Clinic/Center | 1417 N Mount Auburn Rd Ste A2, Cape Girardeau, MO 63701-2171 | 2020-05-07 |
| 1114483468 | Your Optimal Healthcare LLC | Clinic/Center | 300 W 4th St Ste H, Eureka, MO 63025-1839 | 2019-02-12 |
| 1306313051 | Country Care Family Clinic, LLC | Clinic/Center | 3 E Cleveland Ave, Ellsinore, MO 63937 | 2018-10-31 |
| 1285118950 | Vera Whole Health, Wa PC | Clinic/Center | 8350 N. Church Road, Kansas City, MO 64158 | 2018-09-19 |
| 1003324542 | Quad/med, LLC | Clinic/Center | 2015 Ne Jefferson Street, Grain Valley, MO 64029 | 2018-01-18 |
| 1093267601 | Careatc-saint Peter | Clinic/Center | 4601 Executive Centre Pkwy, Saint Peters, MO 63376-1683 | 2016-10-30 |
| 1407303480 | Kerns Family Health Care LLC | Clinic/Center | 1335 Vilage Dr B, St. Joseph, MO 64506-2457 | 2016-09-07 |
| 1316491020 | Wecare Tlc - Wwt Mo Family Health Center | Clinic/Center | 58 Weldon Pkwy, Bldg 58, Maryland Heights, MO 63043-3237 | 2016-08-10 |
| 1255703500 | Community Hospital Association | Clinic/Center | 101 South Washington Street, Oregon, MO 64473 | 2015-10-27 |
| 1023485752 | Dennis E. Robinson D.o. | Clinic/Center | 487 Pomme De Terre Dr., Marshfield, MO 65706 | 2015-08-28 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CHOTCHAI BOONKHAM MD PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.