Provider Demographics
NPI:1225437585
Name:SDG PRIMARY AND IMMEDIATE CARE LLC
Entity Type:Organization
Organization Name:SDG PRIMARY AND IMMEDIATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-676-1840
Mailing Address - Street 1:201 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-1547
Mailing Address - Country:US
Mailing Address - Phone:731-836-5617
Mailing Address - Fax:731-836-5284
Practice Address - Street 1:201 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-1547
Practice Address - Country:US
Practice Address - Phone:731-836-5617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007486Medicaid