Organization
ORANGE GROVE CENTER, INC.
Active
Parent organization
ORANGE GROVE CENTER, INC.
Other names
Orange Grove Center Primary Health Care Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORANGE GROVE CENTER, INC.
Authorized official
MS. TERA ROBERTS (CEO)
(423) 493-2910
Entity
Organization
Contact information
Practice address
615 DERBY ST, CHATTANOOGA, TN 37404-1632
(423) 493-2905
(423) 493-2950
Mailing address
615 DERBY ST, ATTENTION: HEALTH INFORMATICS & REIMBURSEMENT, CHATTANOOGA, TN 37404-1632
(423) 493-2906
(423) 493-2950
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
8686
TN
207QA0505X
Adult Medicine Physician
Primary
26723
TN
363LP2300X
Primary Care Nurse Practitioner
13774
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3070512
BCBS ID
TN
05
—
3399927
—
TN
01
—
CH3763
RR MEDICARE
TN
Enumeration date
01/24/2007
Last updated
03/04/2024
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