Provider Demographics
NPI:1659467033
Name:WOMEN'S INSTITUTE FOR SPECIALIZED HEALTH, PLLC
Entity Type:Organization
Organization Name:WOMEN'S INSTITUTE FOR SPECIALIZED HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-697-7843
Mailing Address - Street 1:721 GLENWOOD DRIVE
Mailing Address - Street 2:SUITE 556W
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-697-7843
Mailing Address - Fax:423-697-7564
Practice Address - Street 1:75 BEN DRIVE, NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-472-6561
Practice Address - Fax:423-472-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709227Medicare ID - Type UnspecifiedGROUP LOCATION ID #