=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619766847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRICITIES HEALTHCARE SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2025
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 E MAIN BLVD
-----------------------------------------------------
City | CHURCH HILL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37642-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-256-2196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1219 BARNSLEY PL
-----------------------------------------------------
City | KINGSPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37660-1197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-256-2196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PUSHKAS GOPALAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 423-381-4186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------