Provider Demographics
NPI:1649221938
Name:PURIHIN CLINIC-P. C.
Entity Type:Organization
Organization Name:PURIHIN CLINIC-P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:PADIERNOS
Authorized Official - Last Name:CHIOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-784-3323
Mailing Address - Street 1:3535 CHERE CAROL RD
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-3634
Mailing Address - Country:US
Mailing Address - Phone:731-784-3323
Mailing Address - Fax:731-784-3324
Practice Address - Street 1:3535 CHERE CAROL RD
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3634
Practice Address - Country:US
Practice Address - Phone:731-784-3323
Practice Address - Fax:731-784-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35377207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20481OtherMEMPHIS MANAGED CARE
5724187OtherAETNA
TN3374104OtherCIGNA
110229501OtherRAILROAD MEDICARE NUMBER
TN4021754OtherBLUE CROSS BLUE SHIELD
TN3374104Medicaid
TN3374104OtherCIGNA
110229501OtherRAILROAD MEDICARE NUMBER
5724187OtherAETNA