| 1101 Primary Care, Pllc | |
|
1101 Neal St Cookeville TN 38501-0901 | |
| (931) 528-7797 | |
| Not Available |
| Full Name | 1101 Primary Care, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1101 Neal St, Cookeville, Tennessee |
| Authorized Official Name and Position | Carolyn Shirley (PRACTICE MANAGER) |
| Authorized Official Contact | 9315287797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 1101 Primary Care, Pllc 1101 Neal St Cookeville TN 38501-0901 Ph: (931) 528-7797 | 1101 Primary Care, Pllc 1101 Neal St Cookeville TN 38501-0901 Ph: (931) 528-7797 |
| NPI Number | 1083074587 |
|---|---|
| Provider Enumeration Date | 02/26/2016 |
| Last Update Date | 02/06/2020 |
| Medicare PECOS PAC ID | 6305192972 |
|---|---|
| Medicare Enrollment ID | O20180712000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083074587 | NPI | - | NPPES |
| Q020668 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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