Provider Demographics
NPI:1679772099
Name:CHATTANOOGA DIAGNOSTIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:CHATTANOOGA DIAGNOSTIC ASSOCIATES LLC
Other - Org Name:DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:2205 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3230
Mailing Address - Country:US
Mailing Address - Phone:423-698-2435
Mailing Address - Fax:423-697-6110
Practice Address - Street 1:2205 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3230
Practice Address - Country:US
Practice Address - Phone:423-698-2435
Practice Address - Fax:423-697-6110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HTI HOSPITAL HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-16
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370099Medicaid
TN3370099Medicare PIN
TN3370099Medicaid