Provider Demographics
NPI:1225256209
Name:BRENTWOOD PRIMARY CARE
Entity Type:Organization
Organization Name:BRENTWOOD PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-377-3300
Mailing Address - Street 1:343 FRANKLIN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5213
Mailing Address - Country:US
Mailing Address - Phone:615-377-3300
Mailing Address - Fax:675-377-8792
Practice Address - Street 1:343 FRANKLIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5213
Practice Address - Country:US
Practice Address - Phone:615-377-3300
Practice Address - Fax:675-377-8792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3720154Medicare ID - Type Unspecified