Prodigal Primary Care

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PRODIGAL PRIMARY CARE

Practice address

9221 Middlebrook Pike
Suite 102
Knoxville, TN 37931-4764

Phone

(865) 288-3754

Fax

(865) 539-2969

NPI assigned

Jun 21, 2013

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

Title

PA

Phone

(865) 288-3754

Specialties & licenses 1

Addresses

Tax ID family

Prodigal Primary Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prodigal Primary Care PC

  • Durable Medical Equipment & Medical Supplies
  • Knoxville, TN
  • NPI 1063762649
  NPD tax ID

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371772800000",
    "number": "1407295587",
    "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": "865-288-3754",
            "fax_number": "865-254-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9221 MIDDLEBROOK PIKE",
            "address_2": "SUITE 102",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379314764",
            "telephone_number": "865-288-3754",
            "fax_number": "865-539-2969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGAL PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-06-21",
        "status": "A",
        "authorized_official_last_name": "BRICKHOUSE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PA",
        "authorized_official_telephone_number": "865-288-3754",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Lynn Proctor, M.ED., LPC-MHSP
• Ramona Phillips Proctor
• Riann Joan-Garbett Proctor, LCSW
• Sarah Proctor, LMFT
• Prodigal Family Healthcare
• Prodigal Primary Care PC
• Prodigal Primary Care PC
• Prodigal Primary Care PC
• Prodigy Mobile Lab & Nursing Concierge
• Professional Dental Systems, North

• Durable Medical Equipment & Medical Supplies in Knoxville, TN
• Providers in Knoxville, 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 Jun 21, 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.