Provider Demographics
NPI:1326768870
Name:MADISONVILLE PRIMARY CARE GROUP
Entity Type:Organization
Organization Name:MADISONVILLE PRIMARY CARE GROUP
Other - Org Name:UNITED PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:423-442-2121
Mailing Address - Street 1:3959 US 411
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-1571
Mailing Address - Country:US
Mailing Address - Phone:423-442-2121
Mailing Address - Fax:423-545-9556
Practice Address - Street 1:401 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3468
Practice Address - Country:US
Practice Address - Phone:423-745-6610
Practice Address - Fax:423-745-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care