Healthcare Provider Details

I. General information

NPI: 1760424949
Provider Name (Legal Business Name): PARKRIDGE EAST SPECIALTY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 SPRING CREEK RD SUITE 300
CHATTANOOGA TN
37412-3909
US

IV. Provider business mailing address

961 SPRING CREEK RD SUITE 300
CHATTANOOGA TN
37412-3909
US

V. Phone/Fax

Practice location:
  • Phone: 423-892-5013
  • Fax:
Mailing address:
  • Phone: 423-892-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF RYDBURG
Title or Position: VP
Credential:
Phone: 615-373-7415