1366629909 NPI number — CHRISTOPHER SEGLER

Table of content: (NPI 1366629909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366629909 NPI number — CHRISTOPHER SEGLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER SEGLER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANKLE & FOOT CENTER OF CHATTANOOGA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366629909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5870 HIGHWAY 153
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-5826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-877-8870
Provider Business Mailing Address Fax Number:
423-877-8878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5870 HIGHWAY 153
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-5826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-877-8870
Provider Business Practice Location Address Fax Number:
423-877-8878
Provider Enumeration Date:
01/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SEGLER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SOLE PROPRIETOR
Authorized Official Telephone Number:
423-877-8870

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  DPM648 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3354294 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5878396 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3354294 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 52218116001 . This is a "BCBS GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 408257618 . This is a "TRICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00377796 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0101 . This is a "JOHN DEERE HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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