Provider Demographics
NPI:1639447303
Name:CIRCE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:CIRCE MEDICAL SERVICES LLC
Other - Org Name:URGENT CARE & SURGERY CENTER CHATTANOOGA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-282-1171
Mailing Address - Street 1:PO BOX 5751
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5751
Mailing Address - Country:US
Mailing Address - Phone:423-282-1171
Mailing Address - Fax:423-282-1181
Practice Address - Street 1:411 PRINCETON RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-282-1171
Practice Address - Fax:423-282-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38667208D00000X
TN38667208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID
TN103G707654Medicare UPIN
TN1528534Medicaid
TN3643190Medicaid