Provider Demographics
NPI:1164541579
Name:FERTILITY CENTER, LLC
Entity Type:Organization
Organization Name:FERTILITY CENTER, LLC
Other - Org Name:THE FERTILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SIMMONS
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-899-0500
Mailing Address - Street 1:PO BOX 21867
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0867
Mailing Address - Country:US
Mailing Address - Phone:423-899-0500
Mailing Address - Fax:423-899-2411
Practice Address - Street 1:7407 ZIEGLER ROAD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3157
Practice Address - Country:US
Practice Address - Phone:423-899-0500
Practice Address - Fax:423-899-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44D0310043Medicaid