Provider Demographics
NPI:1841260809
Name:CHATTANOOGA MOBILITY CENTER, INC.
Entity type:Organization
Organization Name:CHATTANOOGA MOBILITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-875-3456
Mailing Address - Street 1:4825 DAYTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-1753
Mailing Address - Country:US
Mailing Address - Phone:423-875-3456
Mailing Address - Fax:423-875-4517
Practice Address - Street 1:4825 DAYTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-1753
Practice Address - Country:US
Practice Address - Phone:423-875-3456
Practice Address - Fax:423-875-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000683332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454647Medicaid
TN4096617OtherBLUECROSSPROVIDERNUMBER
TN1454647Medicaid