1669164232 NPI number — PRIMARY CARE AT PUC

Table of content: (NPI 1669164232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669164232 NPI number — PRIMARY CARE AT PUC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE AT PUC
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:
1669164232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 COVEY DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-6019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-472-1550
Provider Business Mailing Address Fax Number:
615-472-1659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 OLD HICKORY BLVD STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-5462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-457-3864
Provider Business Practice Location Address Fax Number:
615-457-3876
Provider Enumeration Date:
05/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
RUBINO
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
615-457-3864

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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