Southeast Community Service Agency

Primary specialty

Transportation BrokerTaxonomy code 347E00000X

Legal business name

SOUTHEAST COMMUNITY SERVICE AGENCY

Practice address

1501 Riverside Dr
105
Chattanooga, TN 37406-4309

Phone

(423) 634-6966

Fax

(423) 634-6120

NPI assigned

Jan 30, 2007

Last updated

Jul 13, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Reshonda Shanay Goins

Title

Coordinator

Phone

(423) 634-6966

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184284800000",
    "number": "1639215171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 RIVERSIDE DR",
            "address_2": "105",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374064309",
            "telephone_number": "423-634-6966",
            "fax_number": "423-634-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 RIVERSIDE DR",
            "address_2": "105",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374064309",
            "telephone_number": "423-634-6966",
            "fax_number": "423-634-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COMMUNITY SERVICE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-13",
        "status": "A",
        "authorized_official_last_name": "GOINS",
        "authorized_official_first_name": "RESHONDA",
        "authorized_official_middle_name": "SHANAY",
        "authorized_official_title_or_position": "COORDINATOR",
        "authorized_official_telephone_number": "423-634-6966",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "347E00000X",
            "taxonomy_group": "",
            "desc": "Transportation Broker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T000208",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southeast Ambulance, LLC
• Southeast Center for Regenerative Wound Care PC
• Southeast Eye Specialists PLLC
• Southeast Surgical Solutions LLC
• Southeast Tennessee Health Clinic, LLC
• Southeast Tennessee Human Resource Agency/Hamilton County
• Southeast Tennessee Spine and Nerve Institute PLLC

• Transportation Broker in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Transportation Broker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; 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.