MEDICARE: LOOKOUT VALLEY MEDICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386686913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOOKOUT VALLEY MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	3309 CUMMINGS HWY
Second Line	:	SUITE A
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2360
Country	:	US
Telephone Number	:	423-648-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 CUMMINGS HWY
Second Line	:	SUITE A
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2360
Country	:	US
Telephone Number	:	423-648-4800
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	CHUCK LOCKE
Credential	:
Telephone Number	:	423-648-4800

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/28/2007

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Directions to “LOOKOUT VALLEY MEDICAL CENTER, LLC ” Practice Location

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