Basic Information
| Provider Information | |||||||||
| NPI: | 1083671085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TESSEMA | ||||||||
| FirstName: | BELAY | ||||||||
| MiddleName: | ESHETE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ESHETE | ||||||||
| OtherFirstName: | BELAY | ||||||||
| OtherMiddleName: | TESSEMA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1500 NORTH WESTWOOD BLVD | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS | ||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736864151 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 150 DEBRA RD | ||||||||
| Address2: | 5200 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374115616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238936500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | 36345 | TN | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 207R00000X | 36345 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.