Provider Demographics
NPI:1265751283
Name:CHRISTINE PHAM PLLC
Entity type:Organization
Organization Name:CHRISTINE PHAM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-7527
Mailing Address - Street 1:2995 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7721
Mailing Address - Country:US
Mailing Address - Phone:931-787-1362
Mailing Address - Fax:931-210-5362
Practice Address - Street 1:317 N HICKORY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2428
Practice Address - Country:US
Practice Address - Phone:931-528-7527
Practice Address - Fax:931-372-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46344207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519920Medicaid
TN103G164759Medicare PIN