Providence Family Medicine, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

37235 Issued in TN

Legal business name

PROVIDENCE FAMILY MEDICINE, PLLC

Practice address

1210 Briarville Rd BLDG E
Madison, TN 37115-5136

Phone

(615) 860-8182

Fax

(615) 860-8184

NPI assigned

Oct 24, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Wendy G Myles, RMA

Title

Office Manager

Phone

(615) 860-8182

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1376722546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 BRIARVILLE RD BLDG E",
            "city": "MADISON",
            "state": "TN",
            "postal_code": "371155136",
            "telephone_number": "615-860-8182",
            "fax_number": "615-860-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 BRIARVILLE RD BLDG E",
            "city": "MADISON",
            "state": "TN",
            "postal_code": "371155136",
            "telephone_number": "615-860-8182",
            "fax_number": "615-860-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "MYLES",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-860-8182",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RMA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "37235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP",
            "identifier": "1376722546",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Levi Clayton Primasing
• Mary Rachel Prisco, FNP
• Joe Michael Pritchard, LPC
• Kailey Proffitt
• Progressive Families
• Raeann Prusia
• Prusinski Therapy
• Ian Putman
• Pygmy Blue Health LLC
• Jennifer Charlie Radler

• Primary Care Clinic/Center in Madison, TN
• Providers in Madison, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; 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.