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General NPI Number Information
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NPI Number | 1669164232
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE AT PUC
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 700 OLD HICKORY BLVD STE 208
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City | BRENTWOOD
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State | TN
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Zip | 37027-5462
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Country | US
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Telephone | 615-457-3864
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Fax | 615-457-3876
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Provider Business Mailing Address
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Address Line | 155 COVEY DR STE 100
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City | FRANKLIN
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State | TN
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Zip | 37067-6019
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Country | US
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Telephone | 615-472-1550
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Fax | 615-472-1659
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JASON RUBINO
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Credential | MD
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Telephone | 615-457-3864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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