Provider Demographics
NPI:1396091229
Name:ALEXIAN BROTHERS PACE
Entity type:Organization
Organization Name:ALEXIAN BROTHERS PACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR.PLANNING AND COMMUNICATION
Authorized Official - Prefix:
Authorized Official - First Name:CRISS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-698-0802
Mailing Address - Street 1:425 CUMBERLAND ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1909
Mailing Address - Country:US
Mailing Address - Phone:423-495-9126
Mailing Address - Fax:423-495-9145
Practice Address - Street 1:425 CUMBERLAND ST STE 110
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1909
Practice Address - Country:US
Practice Address - Phone:423-495-9126
Practice Address - Fax:423-495-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBSW0000000500OtherDIVISION OF HEALTH RELATED BOARDS