MEDICARE: PREMIER PRIMARY CARE PLLC

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	363LF0000X	Family Nurse Practitioner	18135	TN

General Provider Information

NPI Number	:	1841614005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	1208 EDWARDS ST
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-5320
Country	:	US
Telephone Number	:	731-885-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 EDWARDS ST
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-5320
Country	:	US
Telephone Number	:	731-885-8884
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TINA WRIGHT
Credential	:
Telephone Number	:	731-885-8884

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	07/15/2014

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