Provider Demographics
NPI:1427132786
Name:PARKWEST MEDICAL CENTER
Entity type:Organization
Organization Name:PARKWEST MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GEPPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-6872
Mailing Address - Street 1:PO BOX 1999
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777
Mailing Address - Country:US
Mailing Address - Phone:865-970-1295
Mailing Address - Fax:865-380-1461
Practice Address - Street 1:2341 JONES BEND RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:865-380-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL2370761471322D00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0440173Medicaid
TN0440173Medicaid