Provider Demographics
NPI:1801892609
Name:PRIMARY CARE ASSOCIATES PC
Entity type:Organization
Organization Name:PRIMARY CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ZIEGLER
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:865-882-3211
Mailing Address - Street 1:413 DEVONIA ST
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2010
Mailing Address - Country:US
Mailing Address - Phone:865-882-3211
Mailing Address - Fax:865-882-9889
Practice Address - Street 1:413 DEVONIA ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2010
Practice Address - Country:US
Practice Address - Phone:865-882-3211
Practice Address - Fax:865-882-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD005463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006767OtherBLUE CROSS
TN3373554Medicaid
TNCB4807OtherRAILROAD MEDICARE
TN3373554Medicaid