Provider Demographics
NPI:1689614521
Name:PARKRIDGE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:PARKRIDGE MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-493-1293
Mailing Address - Street 1:2333 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3258
Mailing Address - Country:US
Mailing Address - Phone:423-698-6061
Mailing Address - Fax:423-493-1208
Practice Address - Street 1:2333 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3258
Practice Address - Country:US
Practice Address - Phone:423-698-6061
Practice Address - Fax:423-493-1208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKRIDGE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044T156Medicaid
44T156Medicare Oscar/Certification