Provider Demographics
NPI:1821531625
Name:MEADOW SPRING PRIMARY CARE
Entity type:Organization
Organization Name:MEADOW SPRING PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-475-4988
Mailing Address - Street 1:1526 MEADOW SPRING DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2041
Mailing Address - Country:US
Mailing Address - Phone:865-475-4988
Mailing Address - Fax:865-475-4350
Practice Address - Street 1:1526 MEADOW SPRING DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760
Practice Address - Country:US
Practice Address - Phone:865-475-4988
Practice Address - Fax:865-475-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO962207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty