Provider Demographics
NPI:1902415490
Name:BASKET MEDICAL PLLC
Entity Type:Organization
Organization Name:BASKET MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-362-4142
Mailing Address - Street 1:6221 SHALLOWFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1972
Mailing Address - Country:US
Mailing Address - Phone:423-648-2053
Mailing Address - Fax:
Practice Address - Street 1:6221 SHALLOWFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1972
Practice Address - Country:US
Practice Address - Phone:423-648-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty