Provider Demographics
NPI:1447232038
Name:WOMENS HEALTH SERVICES CHATTANOOGA PC
Entity Type:Organization
Organization Name:WOMENS HEALTH SERVICES CHATTANOOGA PC
Other - Org Name:PREMIER HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BESSIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:INGRAM NUNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-702-7667
Mailing Address - Street 1:251 N LYERLY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2743
Mailing Address - Country:US
Mailing Address - Phone:423-702-7667
Mailing Address - Fax:423-702-7668
Practice Address - Street 1:251 N LYERLY ST STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2743
Practice Address - Country:US
Practice Address - Phone:423-702-7667
Practice Address - Fax:423-702-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716352Medicaid
TN3716352Medicare PIN