Basic Information
| Provider Information | |||||||||
| NPI: | 1144719808 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TN PREMIER CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3609 OUTDOOR SPORTSMAN PL STE 7 | ||||||||
| Address2: | |||||||||
| City: | KODAK | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377641477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652815922 | ||||||||
| FaxNumber: | 8657665396 | ||||||||
| Practice Location | |||||||||
| Address1: | 3609 OUTDOOR SPORTSMAN PL STE 7 | ||||||||
| Address2: | |||||||||
| City: | KODAK | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652815922 | ||||||||
| FaxNumber: | 8657665396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2018 | ||||||||
| LastUpdateDate: | 12/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | CLARKE | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8652815922 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TN PREMIER CARE | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
| NPICertificationDate: | 12/10/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.