Provider Demographics
NPI:1457518227
Name:C. ANN MASHCHAK, M.D.
Entity Type:Organization
Organization Name:C. ANN MASHCHAK, M.D.
Other - Org Name:GYNPLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MASHCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-624-9830
Mailing Address - Street 1:PO BOX 848873
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8873
Mailing Address - Country:US
Mailing Address - Phone:423-624-9830
Mailing Address - Fax:423-624-0773
Practice Address - Street 1:9413 APISON PIKE
Practice Address - Street 2:SUITE 124
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8661
Practice Address - Country:US
Practice Address - Phone:423-624-9830
Practice Address - Fax:423-624-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2004710OtherBLUE CROSS BLUE SHIELD
TN3032077Medicaid
TN3032077Medicaid
3032078Medicare PIN