NPIMap

Organization Active NPI

Mose and Garrison Siskin Memorial Foundation, Inc.

Doing business as Siskin Center for Developmental Pediatrics

  • Specialist
  • Chattanooga, TN
National Provider Identifier
1902132509
Registry record updated Oct 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.
Doing business as
Siskin Center for Developmental Pediatrics
Practice address
1101 Carter St
Chattanooga, TN 37402-5017
Phone
(423) 490-7710
Fax
(423) 490-7750
NPI assigned
Nov 2, 2009
Last updated
Oct 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2019

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

Authorized official

Name
Stephanie Cooper-Wilkes
Title
Director Healthcare Administration
Phone
(423) 490-7727

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary
Developmental - Behavioral Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0006X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1101 Carter St
Chattanooga, TN 37402-5017

Mailing address

1101 Carter St
Chattanooga, TN 37402-5017
Phone (423) 490-7710

Other practice location 1

2201 Murphy Ave Ste 306
Nashville, TN 37203-1958
Phone (423) 490-7710

Other identifiers 2

IdentifierTypeStateIssuer
003136978AMedicaidGA
1527698MedicaidTN

Other names 1

  • Siskin Center for Developmental Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mose and Garrison Siskin Memorial Foundation3 organizations share this tax ID, including this one
Part of
Mose and Garrison Siskin Memorial Foundation

Other organizations with this tax ID 2

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

Locations

55 Merritt St SE Ste 399
Marietta, GA 30060

1101 Carter St
Ste 1
Chattanooga, TN 37402

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571961600000",
    "number": "1902132509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 CARTER ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374025017",
            "telephone_number": "423-490-7710",
            "fax_number": "423-490-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 CARTER ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374025017",
            "telephone_number": "423-490-7710",
            "fax_number": "423-490-7750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2201 Murphy Ave Ste 306",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372031958",
            "country_code": "US",
            "telephone_number": "423-490-7710",
            "fax_number": "423-490-7750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.",
        "enumeration_date": "2009-11-02",
        "last_updated": "2019-10-25",
        "status": "A",
        "authorized_official_last_name": "COOPER-WILKES",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "DIRECTOR HEALTHCARE ADMINISTRATION",
        "authorized_official_telephone_number": "423-490-7727"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003136978A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527698",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siskin Center for Developmental Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Siskin Center for Developmental Pediatrics",
            "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 Oct 25, 2019; 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.