Provider Demographics
NPI:1801230495
Name:PREMIER CARE PEDIATRICS
Entity Type:Organization
Organization Name:PREMIER CARE PEDIATRICS
Other - Org Name:NESTOR A. OJEDA, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-296-2737
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-0368
Mailing Address - Country:US
Mailing Address - Phone:931-296-2737
Mailing Address - Fax:931-296-1656
Practice Address - Street 1:300 S CLYDETON RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-2140
Practice Address - Country:US
Practice Address - Phone:931-296-2737
Practice Address - Fax:931-296-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN021076208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN003056699Medicaid
TN0111969OtherBLUECROSS BLUESHIELD OF TN