Provider Demographics
NPI:1396786745
Name:COLUMBIA MEDICAL GROUP-PARKRIDGE INC.
Entity type:Organization
Organization Name:COLUMBIA MEDICAL GROUP-PARKRIDGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7604
Mailing Address - Street 1:935 SPRING CREEK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3993
Mailing Address - Country:US
Mailing Address - Phone:423-893-9787
Mailing Address - Fax:
Practice Address - Street 1:935 SPRING CREEK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3993
Practice Address - Country:US
Practice Address - Phone:423-893-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721128Medicaid
TN3708087Medicaid
CJ8044Medicare PIN
TN3708087Medicare PIN
TN3721128Medicare PIN