MEDICARE: BEN EDGAR COTTRELL MD

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	208M00000X	Hospitalist Physician	35175	TN
2	207P00000X	Emergency Medicine Physician	35175	TN
3	207Q00000X	Family Medicine Physician	35175	TN

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
2	TN0109	OTHER	TN	AMERICHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4144771	OTHER	TN	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801842570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN EDGAR COTTRELL MD

Provider Business Mailing Address
First Line	:	705 BLACK CREEK DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2190
Country	:	US
Telephone Number	:	931-588-6356
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 BLACK CREEK DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2190
Country	:	US
Telephone Number	:	931-588-6356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/06/2016

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Directions to “ BEN EDGAR COTTRELL MD” Practice Location

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