Basic Information
| Provider Information | |||||||||
| NPI: | 1861485146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL OBSTETRICAL CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 MCCALLIE AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236644460 | ||||||||
| FaxNumber: | 4236644466 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 MCCALLIE AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236644460 | ||||||||
| FaxNumber: | 4236785675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 07/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | HATFIELD | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER/EXEC ASSIST | ||||||||
| AuthorizedOfficialTelephone: | 4236644460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 207VM0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3721117 | 05 | TN | MEDICAID |