Healthcare Provider Details

I. General information

NPI: 1902942485
Provider Name (Legal Business Name): PROLEX MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 OLAN MILLS DR
CHATTANOOGA TN
37421
US

IV. Provider business mailing address

2229 OLAN MILLS DR
CHATTANOOGA TN
37421
US

V. Phone/Fax

Practice location:
  • Phone: 423-296-4224
  • Fax: 423-296-4230
Mailing address:
  • Phone: 423-296-4224
  • Fax: 423-296-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateTN

VIII. Authorized Official

Name: LEXIE E WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 423-296-4224