=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336175736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINCENT A. VISCOMI, MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 09/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 GLENWOOD DRIVE SUITE E-680
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37404-1176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-495-7378
-----------------------------------------------------
Fax | 423-495-4425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 24325
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37422-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-495-7378
-----------------------------------------------------
Fax | 423-495-4425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | VINCENT A VISCOMI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 423-495-7378
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------