Organization
THE ASSOCIATES OF MEMORIAL MISSION SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN SHIKOH MD (CHAIRMAN OF THE BOARD)
(423) 648-6672
Entity
Organization
Contact information
Practice address
2515 DESALES AVE, CHATTANOOGA, TN 37404-1100
(423) 648-6672
(423) 648-5312
Mailing address
PO BOX 23785, CHATTANOOGA, TN 37422-3785
(423) 648-6672
(423) 648-5312
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
147
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261507535A
—
GA
05
—
3288753
—
TN
01
—
4053703
BCBS OF TN
TN
Enumeration date
02/27/2006
Last updated
03/12/2009
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