Scenic City Neurotherapy and Ketamine Center LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

SCENIC CITY NEUROTHERAPY AND KETAMINE CENTER LLC

Practice address

7405 Shallowford Rd Ste 240
Chattanooga, TN 37421-2662

Phone

(423) 228-0579

NPI assigned

Mar 9, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Brian Miller, CRNANPI 1376087502

Title

Cmo

Phone

(423) 290-2411

Specialties & licenses 2

Addresses

Other names 1

• Scenic City Neurotherapy Ketamine and TMS Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Brian Miller, RN, APRN, CRNA

  • Certified Registered Nurse Anesthetist
  • Hixson, TN
  • NPI 1376087502

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD Authorized official
• Ahmed A Ibrahim, M.D.

  • Psychiatry Physician
  • Chattanooga, TN
  • NPI 1407188626
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1366077539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7405 SHALLOWFORD RD STE 240",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212662",
            "telephone_number": "423-228-0579",
            "fax_number": "423-702-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7405 SHALLOWFORD RD STE 240",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212662",
            "telephone_number": "423-228-0579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCENIC CITY NEUROTHERAPY AND KETAMINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2023-11-29",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "423-290-2411",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Scenic City Neurotherapy Ketamine and TMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Scenic City Counseling Collective PLLC
• Scenic City Dietetics
• Scenic City Medical Equipment LLC
• Scenic City Medical Equipment LLC
• Scenic City Medical Massage
• Scenic City Nutrition, LLC
• Scenic City Orthodontics PC
• Scenic City Orthopaedics & Sports Medicine, PLLC
• Scenic City Pediatrics PLLC
• Scenic City Plastic Surgery, LLC

• Certified Registered Nurse Anesthetist in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Certified Registered Nurse Anesthetist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.