Provider Demographics
NPI:1356683205
Name:PARKSIDE INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:PARKSIDE INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:865-218-6677
Mailing Address - Street 1:10810 PARKSIDE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1979
Mailing Address - Country:US
Mailing Address - Phone:865-218-6677
Mailing Address - Fax:865-218-6678
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-218-6677
Practice Address - Fax:865-218-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB59497Medicare UPIN
TNE27977Medicare UPIN
TND45651Medicare UPIN