MEDICARE: PARKWEST MEDICAL CENTER

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		TN
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		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	:	1699757609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWEST MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1999
Second Line	:
City	:	LOUISVILLE
State	:	TN
Zip	:	37777-1999
Country	:	US
Telephone Number	:	865-970-1295
Fax Number	:	865-380-1461

Provider Business Practice Location Address
First Line	:	210 SIMMONS ST
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37801-4750
Country	:	US
Telephone Number	:	865-970-9800
Fax Number	:	865-380-1461

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT CFO
Name	:	MR. JOHN T GEPPI
Credential	:
Telephone Number	:	865-374-6872

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	09/11/2025

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Directions to “PARKWEST MEDICAL CENTER ” Practice Location

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