Prodigal Primary Care PC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PRODIGAL PRIMARY CARE PC

Practice address

721 Highway 321 N
BLD 3
Lenoir City, TN 37771-5003

Phone

(865) 288-3754

Fax

(865) 394-6719

NPI assigned

Sep 14, 2012

Organization subpart

No

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

Authorized official

Name

Mr. David E Brickhouse, PA-C

Title

Owner

Phone

(865) 288-3754

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383264000000",
    "number": "1306196530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 ESSARY DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379182468",
            "telephone_number": "865-288-3867",
            "fax_number": "865-394-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 HIGHWAY 321 N",
            "address_2": "BLD 3",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377715003",
            "telephone_number": "865-288-3754",
            "fax_number": "865-394-6719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGAL PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2013-11-01",
        "status": "A",
        "authorized_official_last_name": "BRICKHOUSE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-288-3754",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Lenoir City, TN
• Providers in Lenoir City, TN by specialty
• Durable Medical Equipment & Medical Supplies in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; 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.