Provider Demographics
NPI:1841592573
Name:PARKRIDGE PROFESSIONALS, INC
Entity Type:Organization
Organization Name:PARKRIDGE PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ST.PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-493-1293
Mailing Address - Street 1:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-0130
Mailing Address - Country:US
Mailing Address - Phone:423-493-1739
Mailing Address - Fax:423-493-1448
Practice Address - Street 1:2333 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3258
Practice Address - Country:US
Practice Address - Phone:423-698-6061
Practice Address - Fax:423-493-1208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKRIDGE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty