Provider Demographics
NPI:1093213332
Name:PREFERRED PRIMARY CARE
Entity Type:Organization
Organization Name:PREFERRED PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-498-3601
Mailing Address - Street 1:6031 SHALLOWFORD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1984
Mailing Address - Country:US
Mailing Address - Phone:423-498-3601
Mailing Address - Fax:423-498-3603
Practice Address - Street 1:6031 SHALLOWFORD RD STE 105
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-498-3601
Practice Address - Fax:423-498-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2087261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care