| Tri State Psychiatric Services Pc | |
|
6918 Shallowford Rd Suite 200 Chattanooga TN 37421 | |
| (423) 499-6165 | |
| (423) 499-0693 |
| Full Name | Tri State Psychiatric Services Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6918 Shallowford Rd, Chattanooga, Tennessee |
| Authorized Official Name and Position | Ramesh C Appareddy (SECRETARY OF CORPORATION) |
| Authorized Official Contact | 4235054693 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri State Psychiatric Services Pc 6918 Shallowford Rd Suite 200 Chattanooga TN 37421 Ph: (423) 499-6165 | Tri State Psychiatric Services Pc 6918 Shallowford Rd Suite 200 Chattanooga TN 37421 Ph: (423) 499-6165 |
| NPI Number | 1730259615 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2365459385 |
|---|---|
| Medicare Enrollment ID | O20110127001005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730259615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD022212 (Tennessee) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | MD022212 (Tennessee) | Primary |
| Provider Name | Vijayalakshmi Appareddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871663732 PECOS PAC ID: 4789866187 Enrollment ID: I20111109000376 |
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