Provider Demographics
NPI:1700668977
Name:PARKS, JOSEPH T
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:PARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 CRACKER COVE LANE
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8139
Mailing Address - Country:US
Mailing Address - Phone:248-385-4341
Mailing Address - Fax:
Practice Address - Street 1:4043 CRACKER COVE LANE
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8139
Practice Address - Country:US
Practice Address - Phone:248-385-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251E00000XAgenciesHome Health