MEDICARE: PRIMARY HEALTHCARE OF MILLINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	18070	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4040083	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871587519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HEALTHCARE OF MILLINGTON

Provider Business Mailing Address
First Line	:	4772 NAVY RD
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1927
Country	:	US
Telephone Number	:	901-873-4501
Fax Number	:	901-873-4505

Provider Business Practice Location Address
First Line	:	4772 NAVY RD
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-1927
Country	:	US
Telephone Number	:	901-873-4501
Fax Number	:	901-873-4501

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	REGINA S LINDSEY
Credential	:	MD
Telephone Number	:	901-873-4501

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/21/2018

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Directions to “PRIMARY HEALTHCARE OF MILLINGTON ” Practice Location

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