MEDICARE: CORRYTON MEDICAL CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	020291	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588851190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRYTON MEDICAL CENTER P.C.

Provider Business Mailing Address
First Line	:	6310 ROBERTS RD
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3627
Country	:	US
Telephone Number	:	865-688-8815
Fax Number	:	865-688-8831

Provider Business Practice Location Address
First Line	:	6310 ROBERTS RD
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3627
Country	:	US
Telephone Number	:	865-688-8815
Fax Number	:	865-688-8831

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	MR. KALPESH D. PARIKH
Credential	:	M.D.
Telephone Number	:	865-688-8815

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	01/10/2008

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