MEDICARE: ULTIMATE HEALTH CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1669567707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE HEALTH CLINIC PC

Provider Business Mailing Address
First Line	:	PO BOX 10156
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38308-0102
Country	:	US
Telephone Number	:	731-265-1997
Fax Number	:	731-265-0511

Provider Business Practice Location Address
First Line	:	1673 N ROYAL ST
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3607
Country	:	US
Telephone Number	:	731-265-1997
Fax Number	:	731-265-0511

Authorized Official
Title or Position	:	OWNER
Name	:	SAMUEL OLANIYI BADA
Credential	:	MD
Telephone Number	:	731-265-1997

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/25/2022

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