Provider Demographics
NPI:1629233499
Name:BROOME, MEREDITH H (CRNA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:H
Last Name:BROOME
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:L
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E THIRD STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7608
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870057163W00000X
TN166286163W00000X
TN13591367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00744541OtherRAILROAD MEDICARE
GA787232679AMedicaid
GAN491198OtherWELLCARE (GA MEDICAID)
TN4187051OtherBLUE CROSS BLUE SHIELD TN
AL107992Medicaid
TN1509501Medicaid
NC8053530Medicaid
TN3600369Medicare PIN