Provider Demographics
NPI:1013643998
Name:ULTIMATE HEALTH CLINIC NORTH
Entity Type:Organization
Organization Name:ULTIMATE HEALTH CLINIC NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:OLANIYI
Authorized Official - Last Name:BADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-265-1997
Mailing Address - Street 1:1673 N ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3607
Mailing Address - Country:US
Mailing Address - Phone:731-265-1997
Mailing Address - Fax:888-506-5905
Practice Address - Street 1:16 MURRAY GUARD DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3751
Practice Address - Country:US
Practice Address - Phone:731-660-0887
Practice Address - Fax:731-660-9996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ULTIMATE HEALTH CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty