Provider Demographics
NPI:1487917209
Name:CHATTANOOGA CARDIAC CARE LLC
Entity type:Organization
Organization Name:CHATTANOOGA CARDIAC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-495-9581
Mailing Address - Street 1:1017 EXECUTIVE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7910
Mailing Address - Country:US
Mailing Address - Phone:423-495-9581
Mailing Address - Fax:423-495-9583
Practice Address - Street 1:1017 EXECUTIVE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7910
Practice Address - Country:US
Practice Address - Phone:423-495-9581
Practice Address - Fax:423-495-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000022043261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3076909Medicaid
TN3073909Medicare PIN
TN3076909Medicaid