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General NPI Number Information
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NPI Number | 1740256197
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Entity Type | Organization
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Legal Business Name | THE ASSOCIATES OF MEMORIAL MISSION SURGERY CENTER, LLC
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 2515 DESALES AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1100
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Country | US
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Telephone | 423-648-6672
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Fax | 423-648-5312
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Provider Business Mailing Address
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Address Line | PO BOX 23785
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City | CHATTANOOGA
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State | TN
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Zip | 37422-3785
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Country | US
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Telephone | 423-648-6672
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Fax | 423-648-5312
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | DR. ALAN SHIKOH
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Credential | MD
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Telephone | 423-648-6672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 147
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License Number State | TN
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