Provider Demographics
NPI:1760424949
Name:PARKRIDGE EAST SPECIALTY ASSOCIATES LLC
Entity Type:Organization
Organization Name:PARKRIDGE EAST SPECIALTY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7415
Mailing Address - Street 1:961 SPRING CREEK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3909
Mailing Address - Country:US
Mailing Address - Phone:423-892-5013
Mailing Address - Fax:
Practice Address - Street 1:961 SPRING CREEK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3909
Practice Address - Country:US
Practice Address - Phone:423-892-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL CORP., LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3736489Medicaid
TN3736489Medicare PIN