Provider Demographics
NPI:1245465129
Name:PRIMARY CARE PLUS, LLC
Entity type:Organization
Organization Name:PRIMARY CARE PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADHAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-443-1579
Mailing Address - Street 1:10211 AUBURN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2387
Mailing Address - Country:US
Mailing Address - Phone:260-490-8187
Mailing Address - Fax:260-490-3123
Practice Address - Street 1:1405 W BADDOUR PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2567
Practice Address - Country:US
Practice Address - Phone:615-443-1579
Practice Address - Fax:615-443-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2436207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515562Medicaid
TN3373642Medicare PIN