Provider Demographics
NPI:1285838177
Name:OAK RIDGE MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:OAK RIDGE MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VODOPICK-GOSWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-483-7411
Mailing Address - Street 1:170 WEST TENNESSEE AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830
Mailing Address - Country:US
Mailing Address - Phone:865-483-7411
Mailing Address - Fax:865-483-7413
Practice Address - Street 1:170 WEST TENNESSEE AVENUE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-483-7411
Practice Address - Fax:865-483-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD5413261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD5413OtherSTATE LICENSE NUMBER
TN3374883Medicaid
TNB01502Medicare UPIN
TN3374883Medicaid