Provider Demographics
NPI:1619323599
Name:THE UNIVERSITY OF TENNESSEE AT CHATTANOOGA
Entity Type:Organization
Organization Name:THE UNIVERSITY OF TENNESSEE AT CHATTANOOGA
Other - Org Name:UTC STUDENT HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROCURMENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:865-974-3311
Mailing Address - Street 1:615 MCCALLIE AVE
Mailing Address - Street 2:DEPARTMENT 6856
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2504
Mailing Address - Country:US
Mailing Address - Phone:423-425-4111
Mailing Address - Fax:
Practice Address - Street 1:615 MCCALLIE AVE
Practice Address - Street 2:DEPT. 6856
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2504
Practice Address - Country:US
Practice Address - Phone:423-425-2266
Practice Address - Fax:423-425-2305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF TENNESSEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN523RPWMF1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2016-303-1OtherUNITED HEALTHCARE STUDENT RESOURCE PLAN (UHCSR)