Basic Information
| Provider Information | |||||||||
| NPI: | 1841744810 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FPSC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7047 LEE HWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374211793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236489808 | ||||||||
| FaxNumber: | 4236484570 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 EXECUTIVE DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HIXSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373437918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236489808 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2016 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | GOMEZ | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | ALBERTO | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4236489808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 51386 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.