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NPI Code Detail

MEDICARE: MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.

MEDICARE: MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.
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
12080P0006XDevelopmental - Behavioral Pediatrics Physician
2363A00000XPhysician Assistant
3363L00000XNurse Practitioner
4174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902132509
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.
Provider Business Mailing Address
First Line : 1101 CARTER ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-5017
Country : US
Telephone Number : 423-490-7710
Fax Number : 423-490-7750
Provider Business Practice Location Address
First Line : 1101 CARTER ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-5017
Country : US
Telephone Number : 423-490-7710
Fax Number : 423-490-7750
Authorized Official
Title or Position : DIRECTOR HEALTHCARE ADMINISTRATION
Name : STEPHANIE COOPER-WILKES
Credential :
Telephone Number : 423-490-7727
Provider Enumeration Date : 11/02/2009
Last Update Date : 10/25/2019

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