Provider Demographics
NPI:1457692667
Name:FIRST CARE FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:FIRST CARE FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:423-486-9455
Mailing Address - Street 1:14821 DAYTON PIKE, PO BOX 698
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALE CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37373
Mailing Address - Country:US
Mailing Address - Phone:423-486-9455
Mailing Address - Fax:423-486-9458
Practice Address - Street 1:14821 DAYTON PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:SALE CREEK
Practice Address - State:TN
Practice Address - Zip Code:37373
Practice Address - Country:US
Practice Address - Phone:423-486-9455
Practice Address - Fax:423-486-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN004944207Q00000X
TNAPN0000005828363L00000X
TNAP16874363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid