Provider Demographics
NPI:1497037451
Name:UCSC PRIMARY CARE
Entity Type:Organization
Organization Name:UCSC PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-992-6060
Mailing Address - Street 1:598 JOHN DEERE DR
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3212
Mailing Address - Country:US
Mailing Address - Phone:865-992-6060
Mailing Address - Fax:865-992-7060
Practice Address - Street 1:598 JOHN DEERE DR
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3212
Practice Address - Country:US
Practice Address - Phone:865-992-6060
Practice Address - Fax:865-992-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty