Provider Demographics
NPI:1336175736
Name:VINCENT A. VISCOMI, MD PC
Entity Type:Organization
Organization Name:VINCENT A. VISCOMI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:VISCOMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-495-7378
Mailing Address - Street 1:PO BOX 24325
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-4325
Mailing Address - Country:US
Mailing Address - Phone:423-495-7378
Mailing Address - Fax:423-495-4425
Practice Address - Street 1:725 GLENWOOD DRIVE
Practice Address - Street 2:SUITE E-680
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1176
Practice Address - Country:US
Practice Address - Phone:423-495-7378
Practice Address - Fax:423-495-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3049230Medicaid
TNDG8484OtherRR MEDICARE TN
TNDG8484OtherRR MEDICARE TN
TN3049230Medicaid