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General NPI Number Information
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NPI Number | 1861780496
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Entity Type | Organization
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Legal Business Name | MADISONVILLE PRIMARY CARE GROUP PLLC
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 3959 HIGHWAY 411
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City | MADISONVILLE
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State | TN
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Zip | 37354-4417
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Country | US
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Telephone | 423-442-2121
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Fax | 423-545-9556
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Provider Business Mailing Address
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Address Line | PO BOX 808
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City | KINGSTON
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State | TN
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Zip | 37763-0808
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Country | US
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Telephone | 865-224-7172
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Fax | 865-224-7171
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY BRIAN CAIN
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Credential | PA
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Telephone | 423-442-2121
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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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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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