Whitwell Medical Plaza

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

WHITWELL MEDICAL PLAZA

Practice address

13851 Highway 28
Whitwell, TN 37397-5373

Phone

(423) 658-9200

Fax

(423) 658-2195

NPI assigned

Oct 19, 2015

Reactivated

Oct 5, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jung Tae Park, M.D.NPI 1942291638

Title

MD-Owner

Phone

(423) 658-9200

Specialties & licenses 1

Addresses

Other names 1

• Jung Tae Park Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jung Tae Park, MD

  • Adult Medicine Physician
  • Whitwell, TN
  • NPI 1942291638
  NPD (past) Authorized official
• Brenda J. Ross, M.D.

  • Emergency Medicine Physician
  • Jasper, TN
  • NPI 1124055801
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509494400000",
    "number": "1225409147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13851 HIGHWAY 28 PO BOX 400",
            "city": "WHITWELL",
            "state": "TN",
            "postal_code": "373975373",
            "telephone_number": "423-658-9200",
            "fax_number": "423-658-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13851 HIGHWAY 28",
            "city": "WHITWELL",
            "state": "TN",
            "postal_code": "373975373",
            "telephone_number": "423-658-9200",
            "fax_number": "423-658-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITWELL MEDICAL PLAZA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-19",
        "last_updated": "2017-11-01",
        "deactivation_date": "2016-04-18",
        "reactivation_date": "2017-10-05",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JUNG",
        "authorized_official_middle_name": "TAE",
        "authorized_official_title_or_position": "MD-OWNER",
        "authorized_official_telephone_number": "423-658-9200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jung Tae Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donald Allen Smith
• Southern Home Care Services, Inc.
• Specialized Behavior Solutions
• Joeleigh Taylor
• Steven S Todd, LADC
• Whitwell Pharmacy Inc
• Whitwell Senior Living, LLC

• Primary Care Clinic/Center in Whitwell, TN
• Providers in Whitwell, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.