Healthcare Provider Details

I. General information

NPI: 1619679487
Provider Name (Legal Business Name): PA FUNDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 GUNBARREL RD STE 500
CHATTANOOGA TN
37421-7175
US

IV. Provider business mailing address

1510 GUNBARREL RD STE 500
CHATTANOOGA TN
37421-7175
US

V. Phone/Fax

Practice location:
  • Phone: 423-888-9568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARIA MENDIOLA
Title or Position: MANAGER
Credential:
Phone: 423-888-9568