Provider Demographics
NPI:1396833372
Name:THE NEUROSURGICAL GROUP OF CHATTANOOGA
Entity Type:Organization
Organization Name:THE NEUROSURGICAL GROUP OF CHATTANOOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-321-1157
Mailing Address - Street 1:1010 E 3RD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2109
Mailing Address - Country:US
Mailing Address - Phone:423-265-2233
Mailing Address - Fax:423-756-8265
Practice Address - Street 1:1010 E 3RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2109
Practice Address - Country:US
Practice Address - Phone:423-265-2233
Practice Address - Fax:423-756-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCB0525OtherRAILROAD MEDICARE
TN3373215Medicare PIN
GAGRP3916Medicare PIN
TNCB0525OtherRAILROAD MEDICARE