NPIMap

Organization Active NPI

University of Tennessee

  • Sports Medicine (Family Medicine) Physician
  • Chattanooga, TN
National Provider Identifier
1376910653
Registry record updated Aug 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
UNIVERSITY OF TENNESSEE
Practice address
615 McCallie Ave
Chattanooga, TN 37403-2504
Phone
(423) 425-5637
Fax
(972) 367-3451
NPI assigned
Aug 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2015

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

Authorized official

Name
Mouzon Bass III
Title
Agent
Phone
(972) 367-4845

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X Primary

Addresses

Primary practice location

615 McCallie Ave
Chattanooga, TN 37403-2504

Mailing address

PO Box 650850
Dallas, TX 75265-0850
Phone (800) 555-9073

Other names 1

  • UTC Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ut CT HLTH SC Fam Prac CT26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

615 McCallie Ave
Chattanooga, TN 37403
Phone (423) 425-4111

NPI Registry JSON

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1376910653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650850",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650850",
            "telephone_number": "800-555-9073",
            "fax_number": "972-367-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 MCCALLIE AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374032504",
            "telephone_number": "423-425-5637",
            "fax_number": "972-367-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UTC Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.