Provider Demographics
NPI:1467794909
Name:BSMD CHATTANOOGA, PC
Entity Type:Organization
Organization Name:BSMD CHATTANOOGA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIKAINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-339-7253
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0321
Mailing Address - Country:US
Mailing Address - Phone:828-586-8160
Mailing Address - Fax:828-586-8209
Practice Address - Street 1:1511 GUNBARREL RD
Practice Address - Street 2:STE 111
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3897
Practice Address - Country:US
Practice Address - Phone:423-553-5999
Practice Address - Fax:423-553-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty