1740358597 NPI number — CHATTANOOGA PLASTIC SURGERY, PLLC

Table of content: (NPI 1740358597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740358597 NPI number — CHATTANOOGA PLASTIC SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATTANOOGA PLASTIC SURGERY, PLLC
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:
Provider Other Organization Name Type Code:
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:
1740358597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 GUNBARREL RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-4136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-826-8200
Provider Business Mailing Address Fax Number:
423-826-8201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 GUNBARREL RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-4136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-826-8200
Provider Business Practice Location Address Fax Number:
423-826-8201
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEECH
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
423-826-8200

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD0000018072 , 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: 5959415 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 260118895 . This is a "TRICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 003154377 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 351793500 . This is a "US DEPART OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4953610 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 139412005329 . This is a "HUMANA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1340106 . This is a "UHC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 602003938 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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