# ORANGE GROVE CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ORANGE GROVE CENTER, INC.
- **Other names:** Orange Grove Center Primary Health Care Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073668653
- **Legal business name:** ORANGE GROVE CENTER, INC.
- **Authorized official:** MS. TERA ROBERTS (CEO)
- **Authorized official phone:** (423) 493-2910

## Contact information

- **Practice address:** 615 DERBY ST, CHATTANOOGA, TN 37404-1632
- **Practice address phone:** (423) 493-2905
- **Practice address fax:** (423) 493-2950
- **Mailing address:** 615 DERBY ST, ATTENTION: HEALTH INFORMATICS & REIMBURSEMENT, CHATTANOOGA, TN 37404-1632
- **Mailing address phone:** (423) 493-2906
- **Mailing address fax:** (423) 493-2950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8686 | TN | — |
| 207QA0505X | Adult Medicine Physician | 26723 | TN | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | 13774 | TN | — |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 03/04/2024