Healthcare Provider Details

I. General information

NPI: 1740798529
Provider Name (Legal Business Name): SALE CREEK PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14402 DAYTON PIKE STE C
SALE CREEK TN
37373-7823
US

IV. Provider business mailing address

14402 DAYTON PIKE STE C
SALE CREEK TN
37373-7823
US

V. Phone/Fax

Practice location:
  • Phone: 423-498-3560
  • Fax: 423-498-3563
Mailing address:
  • Phone: 423-498-3560
  • Fax: 423-498-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY ROSS
Title or Position: OWNER
Credential: PA
Phone: 423-498-3560