Eastside Internal Medicine PC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

31560 Issued in TN

Legal business name

EASTSIDE INTERNAL MEDICINE PC

Practice address

1720 Gunbarrel Road
Suite 206
Chattanooga, TN 37421

Phone

(423) 648-8110

Fax

(423) 443-4297

NPI assigned

Dec 19, 2006

Organization subpart

No

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

Authorized official

Name

Roger Alay

Title

Office Manager

Phone

(423) 648-8110

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318377600000",
    "number": "1427112259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21090",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374240090",
            "telephone_number": "423-648-8110",
            "fax_number": "423-443-4297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 GUNBARREL ROAD",
            "address_2": "SUITE 206",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37421",
            "telephone_number": "423-648-8110",
            "fax_number": "423-443-4297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2011-10-12",
        "status": "A",
        "authorized_official_last_name": "ALAY",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-648-8110"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "TN",
            "license": "31560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3888401",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East TN Neurology LLC
• Eastdale Family Dentistry
• Jonathan Easter
• Brooke Andre' Easterly, LCSW
• Traci Valencia Eastman, APN
• Eastside Pharmacy Inc
• Easy Go Transportation
• Cooper L Eaton, M.A. NCC
• Mari Afanador Eaton, M.D.
• Todd Douglas Eaton, PH.D.

• Health Service Clinic/Center in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Health Service Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; 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.