Provider Demographics
NPI:1265954424
Name:IN CHARGE MEDICAL PROFESSIONALS TN,PC
Entity type:Organization
Organization Name:IN CHARGE MEDICAL PROFESSIONALS TN,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:CZERNEJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-510-6350
Mailing Address - Street 1:2741 W LAYTON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2600
Mailing Address - Country:US
Mailing Address - Phone:414-242-5468
Mailing Address - Fax:888-724-0875
Practice Address - Street 1:709 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402
Practice Address - Country:US
Practice Address - Phone:414-312-5159
Practice Address - Fax:888-724-0875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IN CHARGE MEDICAL PROFESSIONALS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-10
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300015506Medicaid
IN300015508Medicaid
IN300014452Medicaid
IN300015507Medicaid