Provider Demographics
NPI:1447205182
Name:BEACON HEALTH ALLIANCE PC
Entity Type:Organization
Organization Name:BEACON HEALTH ALLIANCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-756-5779
Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:SUITE 480E
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1163
Mailing Address - Country:US
Mailing Address - Phone:423-756-5779
Mailing Address - Fax:423-242-4552
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:SUITE 480E
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-756-5779
Practice Address - Fax:423-242-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714258Medicare PIN
TN3714259Medicare PIN
TN3714256Medicare ID - Type Unspecified
TN3714251Medicare PIN
TN3714252Medicare PIN
TN3714253Medicare ID - Type Unspecified
TN3714254Medicare PIN
TN3714256Medicare PIN
TN3714255Medicare PIN
TN3714257Medicare ID - Type Unspecified
TN3714250Medicare PIN