5170 US RT 60 EAST
HUNTINGTON, WV 25705 US PECOS Enrolled
Chandos Dewayne Tackett
Family Medicine Physician
- HUNTINGTON, WV
- Phone: (304)-528-4663
- Last Updated 5/7/2021
Overview
Chandos Dewayne Tackett is a Family Medicine Physician in the HUNTINGTON area and has over 32 years of experience. Chandos Dewayne Tackett primary office location is at 5170 US RT 60 EAST and new patients are welcome to contact this healthcare provider for an appointment. He attended Jc Edwards School Of Medicine, Marshall University and graduated 1992
Chandos Dewayne Tackett is affiliated with six hospitals in the HUNTINGTON area, including . The NPI number is 1912933151 and the information was updated approximately 3 years ago.
Chandos Dewayne Tackett is affiliated with one medical group in the HUNTINGTON area, ST. MARY'S HIMG, LLC.
We have not detected any Exclusions tied directly to this NPI.
Accepts Medicare Assignment: Unknown
Is sole proprietor: NO
Participates in PECOS: YES (See any PECOS details below)
Contact Information
| License Number | State |
|---|---|
| 18209 | WV |
| Board Certifications |
|---|
| Family Medicine |
| Type/Issuer | Identifier | State |
|---|---|---|
| MEDICAID | 0054285000 | WV |
| RAILROAD MEDICARE | 080068402 | - |
| MEDICAID | 0141822 | OH |
| RAILROAD MEDICARE OHIO | P00472743 | OH |
| Taxonomy | State | Primary? |
|---|---|---|
| Family Medicine Physician - Taxonomy Code 207Q00000X | WV | Y |
PECOS Details:
| Participates in PECOS: | YES |
| PECOS Individual Enrollment ID: | I20040715001420 |
| PECOS Individual PAC ID: | 9638158389 |
| Eligible to order/refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible to order/refer Durable Medical Equipment (DME) | Yes |
| Eligible to order/refer Home Health Agency (HHA) | Yes |
| Eligible to order/refer Power Mobility Devices (PMD) | Yes |
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