Healthcare Provider Details

I. General information

NPI: 1548513286
Provider Name (Legal Business Name): SLENDER WRAP OF CHATTANOOGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 HIGHWAY 153 SUITE D
HIXSON TN
37343-4956
US

IV. Provider business mailing address

5211 HIGHWAY 153 SUITE D
HIXSON TN
37343-4956
US

V. Phone/Fax

Practice location:
  • Phone: 423-802-9848
  • Fax:
Mailing address:
  • Phone: 423-802-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number9807
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JUERGEN MILDENBERGER
Title or Position: PRESIDENT
Credential:
Phone: 423-802-4948