Basic Information
| Provider Information | |||||||||
| NPI: | 1750546552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | TINH | ||||||||
| MiddleName: | HUE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2930 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462062930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238925602 | ||||||||
| FaxNumber: | 8556301300 | ||||||||
| 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: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN143736 | TN | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN177468 | GA | N | Nursing Service Providers | Registered Nurse | 367500000X | APN13575 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 108573 | 05 | AL | MEDICAID | N455527 | 01 | GA | WELLCARE GA | OTHER | 715186013A | 05 | GA | MEDICAID | 1511654 | 05 | TN | MEDICAID | 4187242 | 01 | TN | BLUE CROSS BLUE SHIELD TN | OTHER | 8053504 | 05 | NC | MEDICAID |