MEDICARE: CHILDREN'S UNIVERSITY

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	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1386354173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S UNIVERSITY

Provider Business Mailing Address
First Line	:	2011 BRAGG ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-4508
Country	:	US
Telephone Number	:	423-356-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 BRAGG ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-4508
Country	:	US
Telephone Number	:	423-356-0337
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TOMEKIA E MOORE
Credential	:
Telephone Number	:	423-356-0337

Provider Enumeration Date	:	12/01/2022
Last Update Date	:	12/01/2022

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Directions to “CHILDREN'S UNIVERSITY ” Practice Location

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