MEDICARE: BEACON HEALTH ALLIANCE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033381595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON HEALTH ALLIANCE PC

Provider Business Mailing Address
First Line	:	PO BOX 6159
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37401-6159
Country	:	US
Telephone Number	:	423-495-4939
Fax Number	:	423-495-4970

Provider Business Practice Location Address
First Line	:	632 MORRISON SPRINGS RD
Second Line	:	SUITE 201
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-3402
Country	:	US
Telephone Number	:	423-877-4556
Fax Number	:	423-877-9218

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	SHEILA MANLEY
Credential	:
Telephone Number	:	423-495-4806

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	06/16/2008

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