1659321198 NPI number — PARKRIDGE MEDICAL CENTER, INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659321198 NPI number — PARKRIDGE MEDICAL CENTER, INC.

Employer Identification Number (EIN):

Provider Organization Name:

PARKRIDGE MEDICAL CENTER, INC.

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

PARKRIDGE EAST HOSPITAL

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1659321198

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/02/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3055 LEBANON PIKE

Provider Second Line Business Mailing Address:

BLDG 3 STE 1000

Provider Business Mailing Address City Name:

NASHVILLE

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

37214-2230

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

423-894-7870

Provider Business Mailing Address Fax Number:

423-855-3648

Provider First Line Business Practice Location Address:

941 SPRING CREEK RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHATTANOOGA

Provider Business Practice Location Address State Name:

TN

Provider Business Practice Location Address Postal Code:

37412-3909

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

423-894-7870

Provider Business Practice Location Address Fax Number:

423-855-3648

Provider Enumeration Date:

05/12/2006

Authorized Official Last Name:

PORADA

Authorized Official First Name:

JOHN

Authorized Official Middle Name:

Authorized Official Title or Position:

CFO

Authorized Official Telephone Number:

423-855-3500

• Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1708291 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
• Identifier: 62040204A06 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 911369000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000646A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 010023581 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0440178 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1000039 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 5000070 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 0410175 . This is a "HEALTHSPRING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4400178 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 11458B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 200499750A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".