Basic Information
Provider Information
NPI: 1063724136
EntityType: 2
ReplacementNPI:  
OrganizationName: CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: UNIVERSITY HEALTH OBSTETRICS & GYNECOLOGY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 11589
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374012589
CountryCode: US
TelephoneNumber: 4237782580
FaxNumber: 4237787489
Practice Location
Address1: 979 E 3RD ST
Address2: SUITE C-725
City: CHATTANOOGA
State: TN
PostalCode: 374032136
CountryCode: US
TelephoneNumber: 4237782580
FaxNumber: 4237787489
Other Information
ProviderEnumerationDate: 07/06/2010
LastUpdateDate: 07/06/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: OLSON
AuthorizedOfficialFirstName: CINDY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ADMINISTRATOR
AuthorizedOfficialTelephone: 4237784866
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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