Basic Information
| Provider Information | |||||||||
| NPI: | 1770575490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UT PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 979 E 3RD ST | ||||||||
| Address2: | SUITE 1001 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236489808 | ||||||||
| FaxNumber: | 4236484570 | ||||||||
| Practice Location | |||||||||
| Address1: | 979 E 3RD ST | ||||||||
| Address2: | SUITE 1001 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236489808 | ||||||||
| FaxNumber: | 4236484570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 11/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | HIXSON | ||||||||
| AuthorizedOfficialFirstName: | VELMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4236489808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3707724 | 05 | TN | MEDICAID |