Provider Demographics
NPI:1740798529
Name:SALE CREEK PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:SALE CREEK PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:423-498-3560
Mailing Address - Street 1:14402 DAYTON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:SALE CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37373-7823
Mailing Address - Country:US
Mailing Address - Phone:423-498-3560
Mailing Address - Fax:423-498-3563
Practice Address - Street 1:14402 DAYTON PIKE STE C
Practice Address - Street 2:
Practice Address - City:SALE CREEK
Practice Address - State:TN
Practice Address - Zip Code:37373-7823
Practice Address - Country:US
Practice Address - Phone:423-498-3560
Practice Address - Fax:423-498-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care