Provider Demographics
NPI:1033210117
Name:ARETE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:ARETE MEDICAL SERVICES LLC
Other - Org Name:ARETE MEDICAL SERVICES OF SOUTHEAST TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6080
Mailing Address - Country:US
Mailing Address - Phone:225-298-3548
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:5959 SHALLOWFORD RD
Practice Address - Street 2:SUITE 539
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2285
Practice Address - Country:US
Practice Address - Phone:423-510-0661
Practice Address - Fax:423-510-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicare ID - Type UnspecifiedAPPLIED FOR