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100 Moccasin Bend Rd Chattanooga TN 37405-4415 | |
| (423) 265-2271 | |
| (423) 875-3454 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 100 Moccasin Bend Rd, Chattanooga, Tennessee |
| Authorized Official Name and Position | Rodney Henderson (ADMINISTRATOR) |
| Authorized Official Contact | 4237853321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
100 Moccasin Bend Rd Chattanooga TN 37405-4415 Ph: (423) 265-2271 | 100 Moccasin Bend Rd Chattanooga TN 37405-4415 Ph: (423) 265-2271 |
| NPI Number | 1306818265 |
|---|---|
| Provider Enumeration Date | 02/06/2006 |
| Last Update Date | 03/31/2022 |
| Certification Date | 03/31/2022 |
| Medicare PECOS PAC ID | 5698687077 |
|---|---|
| Medicare Enrollment ID | O20070115000057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306818265 | NPI | - | NPPES |
| 3282227 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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