Provider Demographics
NPI:1386686913
Name:LOOKOUT VALLEY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:LOOKOUT VALLEY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-648-4800
Mailing Address - Street 1:3309 CUMMINGS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2360
Mailing Address - Country:US
Mailing Address - Phone:423-648-4800
Mailing Address - Fax:
Practice Address - Street 1:3309 CUMMINGS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-2360
Practice Address - Country:US
Practice Address - Phone:423-648-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HTI HOSPITAL HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-11
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729953Medicaid
TN3729953Medicaid