Provider Demographics
NPI:1164069084
Name:PREMIER CARE MEDICAL
Entity Type:Organization
Organization Name:PREMIER CARE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-281-5922
Mailing Address - Street 1:3609 OUTDOOR SPORTSMAN PL STE 7
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-1477
Mailing Address - Country:US
Mailing Address - Phone:865-210-3452
Mailing Address - Fax:
Practice Address - Street 1:3609 OUTDOOR SPORTSMAN PL STE 7
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-1477
Practice Address - Country:US
Practice Address - Phone:865-210-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care