1801878830 NPI number — PARKWEST MEDICAL CENTER

Table of content: (NPI 1801878830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801878830 NPI number — PARKWEST MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWEST MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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 Information

NPI Number:
1801878830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1999
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37777-1999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-970-1295
Provider Business Mailing Address Fax Number:
865-380-1461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 COOK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37354-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-970-9800
Provider Business Practice Location Address Fax Number:
865-380-1461
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GEPPI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT CFO
Authorized Official Telephone Number:
865-374-6872

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  L 214-076-1469 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QR0405X , with the licence number: L 214-076-1469 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0440173 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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