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General NPI Number Information
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NPI Number | 1497037451
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Entity Type | Organization
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Legal Business Name | UCSC PRIMARY CARE
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 598 JOHN DEERE DR
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City | MAYNARDVILLE
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State | TN
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Zip | 37807-3212
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Country | US
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Telephone | 865-992-6060
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Fax | 865-992-7060
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Provider Business Mailing Address
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Address Line | 598 JOHN DEERE DR
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City | MAYNARDVILLE
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State | TN
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Zip | 37807-3212
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Country | US
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Telephone | 865-992-6060
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Fax | 865-992-7060
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JON PATRICK DOWNEY
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Credential | M.D.
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Telephone | 865-992-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15988
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License Number State | TN
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