NPIMap

Organization Active NPI

Primecare Clinic, PLLC

  • Family Medicine Physician
  • Bolivar, TN
National Provider Identifier
1194940452
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25889 Issued in TN
Legal business name
PRIMECARE CLINIC, PLLC
Practice address
622 Nuckolls Rd
Bolivar, TN 38008-1532
Phone
(731) 658-2120
NPI assigned
Apr 13, 2007
Last updated
Apr 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barbara Nkomazana
Title
Practice Manager
Phone
(731) 376-1851

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 25889 TN Primary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 38934 TN

Addresses

Primary practice location

622 Nuckolls Rd
Bolivar, TN 38008-1532

Mailing address

PO Box 479
Bolivar, TN 38008-0479

National Provider Directory

National Provider Directory

Locations

107 Tennessee St
Bolivar, TN 38008
Phone (615) 384-1740

100 Chickadee Ave
Middleton, TN 38052
Phone (731) 376-0034

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1194940452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 479",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380080479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081532",
            "telephone_number": "731-658-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "NKOMAZANA",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "731-376-1851"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "25889",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "38934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolivar, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.