Provider Demographics
NPI:1740010826
Name:THE SHOT STOP LLC
Entity type:Organization
Organization Name:THE SHOT STOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIRACUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-218-9819
Mailing Address - Street 1:637 LULLWATER RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4619
Mailing Address - Country:US
Mailing Address - Phone:901-218-9819
Mailing Address - Fax:888-527-6330
Practice Address - Street 1:1200 MOUNTAIN CREEK RD STE 485-5
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1687
Practice Address - Country:US
Practice Address - Phone:901-218-9819
Practice Address - Fax:888-527-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty