Provider Demographics
NPI:1174795645
Name:BEACON HEALTH ALLIANCE PC
Entity type:Organization
Organization Name:BEACON HEALTH ALLIANCE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-495-4806
Mailing Address - Street 1:PO BOX 6159
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-6159
Mailing Address - Country:US
Mailing Address - Phone:423-495-4939
Mailing Address - Fax:423-495-4970
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:SUITE 110B
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6614
Practice Address - Country:US
Practice Address - Phone:423-778-9500
Practice Address - Fax:423-778-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty