Organization
BRISTOL UROLOGICAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD T COUCH MD (PRESIDENT)
(423) 844-6600
Entity
Organization
Contact information
Practice address
350 BLOUNTVILLE HWY, SUITE 105, BRISTOL, TN 37620-0213
(423) 844-6600
(423) 968-1255
Mailing address
350 BLOUNTVILLE HWY, SUITE 105, BRISTOL, TN 37620-0213
(423) 844-6600
(423) 968-1255
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0213340004
UMWA
TN
01
—
064741
ANTHEM
—
01
—
2007375
BLUECROSS BLUESHIELD
TN
01
—
709078
BLUE CROSS BLUE SHIELD PA
—
Enumeration date
10/16/2006
Last updated
06/15/2010
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