Provider Demographics
NPI:1285048900
Name:EMBRYO SERVICES LLC
Entity type:Organization
Organization Name:EMBRYO SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONESKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-899-0500
Mailing Address - Street 1:7407 ZIEGLER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3157
Mailing Address - Country:US
Mailing Address - Phone:423-899-0500
Mailing Address - Fax:423-899-2411
Practice Address - Street 1:7407 ZIEGLER RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3157
Practice Address - Country:US
Practice Address - Phone:423-899-0500
Practice Address - Fax:423-899-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25468174400000X
TNMD21612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE96727Medicare UPIN
TNE95423Medicare UPIN