Provider Demographics
NPI:1194849828
Name:PARKWEST GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:PARKWEST GYNECOLOGY, P.C.
Other - Org Name:PARKWEST OB-GYN, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-531-5878
Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:ST 302
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4308
Mailing Address - Country:US
Mailing Address - Phone:865-531-5878
Mailing Address - Fax:865-531-7690
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:ST 302
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-531-5878
Practice Address - Fax:865-531-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3039850Medicaid
TN3059247Medicaid
TND82566Medicare UPIN
TN3378054Medicare ID - Type UnspecifiedDR STEPHEN DAVIS
TNS54506Medicare UPIN
TN3059247Medicaid
TN3378054Medicare ID - Type UnspecifiedDR SUSAN SCHWARZ