Provider Demographics
NPI:1659321198
Name:PARKRIDGE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PARKRIDGE MEDICAL CENTER, INC.
Other - Org Name:PARKRIDGE EAST HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-855-3500
Mailing Address - Street 1:3055 LEBANON PIKE
Mailing Address - Street 2:BLDG 3 STE 1000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2230
Mailing Address - Country:US
Mailing Address - Phone:423-894-7870
Mailing Address - Fax:423-855-3648
Practice Address - Street 1:941 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3909
Practice Address - Country:US
Practice Address - Phone:423-894-7870
Practice Address - Fax:423-855-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1708291Medicaid
TN62040204A06OtherCIGNA
FL911369000Medicaid
GA000000646AMedicaid
VA010023581Medicaid
TN0440178Medicaid
TN1000039OtherBLUE CROSS
TN5000070OtherUNITED HEALTH CARE
TN0410175OtherHEALTHSPRING
NC4400178Medicaid
SC11458BMedicaid
IN200499750AMedicaid
NC4400178Medicaid
GA000000646AMedicaid