Provider Demographics
NPI:1477513992
Name:CORDOVA PEDIATRICS PLLC
Entity Type:Organization
Organization Name:CORDOVA PEDIATRICS PLLC
Other - Org Name:MONICA WRIGHT MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-531-8555
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0182
Mailing Address - Country:US
Mailing Address - Phone:901-531-8555
Mailing Address - Fax:901-531-8560
Practice Address - Street 1:1665 BONNIE LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016
Practice Address - Country:US
Practice Address - Phone:901-531-8555
Practice Address - Fax:901-531-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000032024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H13160Medicare UPIN