1801892609 NPI number — PRIMARY CARE ASSOCIATES PC

Table of content: (NPI 1801892609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801892609 NPI number — PRIMARY CARE ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801892609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 DEVONIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRIMAN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37748-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-882-3211
Provider Business Mailing Address Fax Number:
865-882-9889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 DEVONIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRIMAN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37748-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-882-3211
Provider Business Practice Location Address Fax Number:
865-882-9889
Provider Enumeration Date:
06/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALLS
Authorized Official First Name:
KIM
Authorized Official Middle Name:
ZIEGLER
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
865-882-3211

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD005463 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2006767 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3373554 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB4807 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".