Provider Demographics
NPI:1124644398
Name:TC MEDICAL OF NEW ALBANY PC
Entity type:Organization
Organization Name:TC MEDICAL OF NEW ALBANY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:662-397-4597
Mailing Address - Street 1:542 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-7262
Mailing Address - Country:US
Mailing Address - Phone:662-397-4597
Mailing Address - Fax:
Practice Address - Street 1:101 CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1302
Practice Address - Country:US
Practice Address - Phone:662-837-3011
Practice Address - Fax:662-837-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty