1619323599 NPI number — THE UNIVERSITY OF TENNESSEE AT CHATTANOOGA

Table of content: (NPI 1619323599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619323599 NPI number — THE UNIVERSITY OF TENNESSEE AT CHATTANOOGA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE UNIVERSITY OF TENNESSEE AT CHATTANOOGA
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:
6
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:
1619323599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 MCCALLIE AVE
Provider Second Line Business Mailing Address:
DEPARTMENT 6856
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37403-2504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-425-4111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 MCCALLIE AVE
Provider Second Line Business Practice Location Address:
DEPT. 6856
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37403-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-425-2266
Provider Business Practice Location Address Fax Number:
423-425-2305
Provider Enumeration Date:
05/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
REAGAN
Authorized Official First Name:
BLAKE
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
DIRECTOR OF PROCURMENT SERVICES
Authorized Official Telephone Number:
865-974-3311

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  523RPWMF1 , 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: 2016-303-1 . This is a "UNITED HEALTHCARE STUDENT RESOURCE PLAN (UHCSR)" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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