Provider Demographics
NPI:1891884292
Name:ID GROUP, PLLC
Entity Type:Organization
Organization Name:ID GROUP, PLLC
Other - Org Name:THE ID GROUP, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-648-9915
Mailing Address - Street 1:1000 EAST THIRD STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-4115
Mailing Address - Country:US
Mailing Address - Phone:423-664-5165
Mailing Address - Fax:423-664-5164
Practice Address - Street 1:1000 EAST THIRD STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-4115
Practice Address - Country:US
Practice Address - Phone:423-664-5165
Practice Address - Fax:423-664-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3712427Medicare ID - Type UnspecifiedGROUP NUMBER