Dr. Bud Polpat Chomhirun
Pain Medicine
1702 Vaughn Rd Suite 1
Wood River
, Illinois 62095-1898
Dr. Bud Polpat Chomhirun
Pain Medicine
1702 Vaughn Rd Suite 1
Wood River
, Illinois 62095-1898
(618) 259-3324
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About
Features
Specialties
- Pain Medicine
Languages spoken
- English
Location
First Address
- Dr. Bud Polpat Chomhirun
- Po Box 53
- Wood River, IL
- Zip : 62095-0053
- Fax : (618) 259-3324
- Phone : (618) 259-3321
Second Address
- Dr. Bud Polpat Chomhirun
- 1702 Vaughn Rd Suite 1
- Wood River, IL
- Zip : 62095-1898
- Fax : (618) 259-3324
- Phone : (618) 259-3321
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2081P2900X | Pain Medicine | 36048379 | IL |
National Provider Identifier
| NPI | 1275697229 |
|---|---|
| Provider Name | Dr. Bud Polpat Chomhirun |
| First Address | Wood River, IL 62095-0053 |
| Second Address | Wood River, IL 62095-1898 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/12/2006 |
| Last Update Date | 10/11/2009 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0006000450 | BLUE CROSS BLUE SHIELD (01) | IL |
| 036048379 | (05) | IL |
| 120057 | ADVANTRA PPO PIN (01) | IL |
| 250002389 | RAILROAD MEDICARE PIN (01) | IL |
| C38896 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.