1760603666 NPI number — CHATTANOOGA BONE & JOINT SURGEONS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760603666 NPI number — CHATTANOOGA BONE & JOINT SURGEONS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATTANOOGA BONE & JOINT SURGEONS, PC
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:
1760603666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 GUNBARREL RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-7185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-893-9020
Provider Business Mailing Address Fax Number:
423-893-9040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 GUNBARREL RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-7185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-893-9020
Provider Business Practice Location Address Fax Number:
423-893-9040
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REDISH
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-893-9020

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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