Provider Demographics
NPI:1871647800
Name:SCENIC CITY RHEUMATOLOGY, PLLC
Entity Type:Organization
Organization Name:SCENIC CITY RHEUMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-893-6890
Mailing Address - Street 1:6145 SHALLOWFORD RD
Mailing Address - Street 2:STE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7808
Mailing Address - Country:US
Mailing Address - Phone:423-893-6890
Mailing Address - Fax:423-648-1115
Practice Address - Street 1:6145 SHALLOWFORD RD
Practice Address - Street 2:STE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7808
Practice Address - Country:US
Practice Address - Phone:423-893-6890
Practice Address - Fax:423-648-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16562174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731246Medicaid
TN4110715OtherBLUE CROSS BLUE SHIELD
TN3731246Medicare PIN
TNE39255Medicare UPIN