Provider Demographics
NPI:1104303924
Name:PRIORITY ONE MEDICAL CARE LLC
Entity type:Organization
Organization Name:PRIORITY ONE MEDICAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:731-599-0261
Mailing Address - Street 1:313 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-3957
Mailing Address - Country:US
Mailing Address - Phone:731-599-0261
Mailing Address - Fax:986-786-5149
Practice Address - Street 1:313 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-3957
Practice Address - Country:US
Practice Address - Phone:731-599-0261
Practice Address - Fax:986-786-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1366098436Medicaid