Provider Demographics
NPI:1871822007
Name:PREMIUM MEDICAL CARE PC
Entity Type:Organization
Organization Name:PREMIUM MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:UGOCHUKU
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYESO-NWACHUKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-321-3511
Mailing Address - Street 1:2201 MURPHY AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1835
Mailing Address - Country:US
Mailing Address - Phone:615-321-3511
Mailing Address - Fax:615-321-3512
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:STE 204
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1835
Practice Address - Country:US
Practice Address - Phone:615-321-3511
Practice Address - Fax:615-321-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3804961Medicaid
TN3804961Medicare PIN