Basic Information
| Provider Information | |||||||||
| NPI: | 1629233499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOME | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOWELL | ||||||||
| OtherFirstName: | MEREDITH | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 11225 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374012225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238925602 | ||||||||
| FaxNumber: | 4238925838 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 E THIRD STREET | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237787608 | ||||||||
| FaxNumber: | 4237782360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 05/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R870057 | MS | N | Nursing Service Providers | Registered Nurse | 163W00000X | 166286 | TN | N | Nursing Service Providers | Registered Nurse | 367500000X | 13591 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00744541 | 01 | TN | RAILROAD MEDICARE | OTHER | 787232679A | 05 | GA | MEDICAID | N491198 | 01 | GA | WELLCARE (GA MEDICAID) | OTHER | 4187051 | 01 | TN | BLUE CROSS BLUE SHIELD TN | OTHER | 107992 | 05 | AL | MEDICAID | 1509501 | 05 | TN | MEDICAID | 8053530 | 05 | NC | MEDICAID |