Provider Demographics
NPI:1619983285
Name:WOMENS HEALTH SERVICES CHATTANOOGA PC
Entity Type:Organization
Organization Name:WOMENS HEALTH SERVICES CHATTANOOGA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-899-0464
Mailing Address - Street 1:6229 VANCE RD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0310
Mailing Address - Country:US
Mailing Address - Phone:423-899-3804
Mailing Address - Fax:423-899-3656
Practice Address - Street 1:6229 VANCE RD
Practice Address - Street 2:SUITE 129
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0310
Practice Address - Country:US
Practice Address - Phone:423-899-3804
Practice Address - Fax:423-899-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716359Medicaid
TN3716359Medicaid