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General NPI Number Information
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NPI Number | 1962196972
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Entity Type | Organization
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Legal Business Name | PREMIER PRIMARY CARE CLINIC INC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 215 HAWKS RD STE 6
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City | MARTIN
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State | TN
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Zip | 38237-2742
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Country | US
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Telephone | 731-281-7501
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Fax | 731-281-7503
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Provider Business Mailing Address
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Address Line | 215 HAWKS RD STE 6
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City | MARTIN
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State | TN
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Zip | 38237-2742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL COLEMAN
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Credential |
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Telephone | 731-415-1172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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