Provider Demographics
NPI:1982602934
Name:MEMORIAL HEALTH CARE SYSTEM INC.
Entity type:Organization
Organization Name:MEMORIAL HEALTH CARE SYSTEM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-495-7878
Mailing Address - Street 1:1949 GUNBARREL RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3188
Mailing Address - Country:US
Mailing Address - Phone:423-495-8550
Mailing Address - Fax:423-495-3780
Practice Address - Street 1:1949 GUNBARREL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3188
Practice Address - Country:US
Practice Address - Phone:423-495-8550
Practice Address - Fax:423-495-3780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HEALTH CARE SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0049499OtherBCBS PROVIDER NUMBER
TN447506Medicare ID - Type Unspecified
TN447506Medicare Oscar/Certification