Provider Demographics
NPI:1992893655
Name:ADULT MEDICINE HEALTH CENTER PC
Entity type:Organization
Organization Name:ADULT MEDICINE HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-2312
Mailing Address - Street 1:929 SPRING CREEK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3964
Mailing Address - Country:US
Mailing Address - Phone:423-855-5484
Mailing Address - Fax:
Practice Address - Street 1:929 SPRING CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3964
Practice Address - Country:US
Practice Address - Phone:423-855-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3305237Medicare ID - Type Unspecified
TNG07562Medicare UPIN