Provider Demographics
NPI:1528201126
Name:PRIMECARE NOW OF COLUMBIA
Entity Type:Organization
Organization Name:PRIMECARE NOW OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:FENNEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-388-0450
Mailing Address - Street 1:1202 SOUTH JAMES CAMPBELL BOULEVARD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-388-0450
Mailing Address - Fax:931-388-0460
Practice Address - Street 1:1202 S JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-5193
Practice Address - Country:US
Practice Address - Phone:931-388-0450
Practice Address - Fax:931-388-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty