| Hyde Park Medical | |
|
741 President Pl Ste 140 Smyrna TN 37167-6808 | |
| (615) 412-8662 | |
| Not Available |
| Full Name | Hyde Park Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 741 President Pl Ste 140, Smyrna, Tennessee |
| Authorized Official Name and Position | Khaisha Gist (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7738022723 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hyde Park Medical Po Box 23 Gladeville TN 37071-0023 Ph: () - | Hyde Park Medical 741 President Pl Ste 140 Smyrna TN 37167-6808 Ph: (615) 412-8662 |
| NPI Number | 1043903990 |
|---|---|
| Provider Enumeration Date | 05/29/2023 |
| Last Update Date | 11/01/2024 |
| Medicare PECOS PAC ID | 7214397785 |
|---|---|
| Medicare Enrollment ID | O20230714003127 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043903990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Khaisha Verdelle Gist |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184011835 PECOS PAC ID: 2961746219 Enrollment ID: I20181128000552 |
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