| South Side Community Health | |
|
3800 Tennessee Ave Ste 124 Chattanooga TN 37409-1260 | |
| (423) 778-4780 | |
| (423) 778-4833 |
| Full Name | South Side Community Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 3800 Tennessee Ave Ste 124, Chattanooga, Tennessee |
| Authorized Official Name and Position | Mike Dale Shaver (DIRECTOR OF REIMBURSEMENT) |
| Authorized Official Contact | 4232408576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Side Community Health 975 E Third Street Chattanooga TN 37403 Ph: (423) 778-4780 | South Side Community Health 3800 Tennessee Ave Ste 124 Chattanooga TN 37409-1260 Ph: (423) 778-4780 |
| NPI Number | 1962597179 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 03/10/2022 |
| Medicare PECOS PAC ID | 0547179731 |
|---|---|
| Medicare Enrollment ID | O20050211000763 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962597179 | NPI | - | NPPES |
| 000451481A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0000000140 (Tennessee) | Primary |
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