Provider Demographics
NPI:1588851190
Name:CORRYTON MEDICAL CENTER P.C.
Entity Type:Organization
Organization Name:CORRYTON MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KALPESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-688-8815
Mailing Address - Street 1:6310 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3627
Mailing Address - Country:US
Mailing Address - Phone:865-688-8815
Mailing Address - Fax:865-688-8831
Practice Address - Street 1:6310 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3627
Practice Address - Country:US
Practice Address - Phone:865-688-8815
Practice Address - Fax:865-688-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN020291261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702628Medicaid
TN1128130001Medicare NSC