Provider Demographics
NPI:1669567707
Name:ULTIMATE HEALTH CLINIC PC
Entity type:Organization
Organization Name:ULTIMATE HEALTH CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:OLANIYI
Authorized Official - Last Name:BADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-265-1997
Mailing Address - Street 1:PO BOX 10156
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0102
Mailing Address - Country:US
Mailing Address - Phone:731-265-1997
Mailing Address - Fax:731-265-0511
Practice Address - Street 1:1673 N ROYAL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3607
Practice Address - Country:US
Practice Address - Phone:731-265-1997
Practice Address - Fax:731-265-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38582502Medicare PIN