1902875164 NPI number — INSIGHT HEALTH CORP

Table of content: (NPI 1902875164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902875164 NPI number — INSIGHT HEALTH CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT HEALTH CORP
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:
CHATTANOOGA OUTPATIENT CENTER
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:
1902875164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 404166
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-4166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-282-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 MCCALLIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-622-7212
Provider Business Practice Location Address Fax Number:
423-624-1557
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRAZBA
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
SENIOR V.P. & CHIEF ACCOUNTING OFCR
Authorized Official Telephone Number:
949-282-6000

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3790234 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00867248A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0102 . This is a "JOHN DEERE HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1640348 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1340536 . This is a "HEALTHSPRINGS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3387166 . This is a "ACCESS MED PLUS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3790234 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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