NPIMap

Organization Active NPI

Family Medical Care Center, LLC

  • Family Nurse Practitioner
  • Corryton, TN
National Provider Identifier
1508021890
Registry record updated Mar 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
FAMILY MEDICAL CARE CENTER, LLC
Practice address
7331 Tazewell Pike
Corryton, TN 37721-3516
Phone
(865) 687-3622
Fax
(865) 687-3632
NPI assigned
Jul 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2015

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

Authorized official

Name
Jamie Bull, APRN, FNP
Title
Managing Member
Phone
(865) 687-3622

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X TN
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

7331 Tazewell Pike
Corryton, TN 37721-3516

Mailing address

7331 Tazewell Pike
Corryton, TN 37721-3516
Phone (865) 687-3622

Other identifiers 1

IdentifierTypeStateIssuer
1521139MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426550400000",
    "number": "1508021890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7331 TAZEWELL PIKE",
            "city": "CORRYTON",
            "state": "TN",
            "postal_code": "377213516",
            "telephone_number": "865-687-3622",
            "fax_number": "865-687-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7331 TAZEWELL PIKE",
            "city": "CORRYTON",
            "state": "TN",
            "postal_code": "377213516",
            "telephone_number": "865-687-3622",
            "fax_number": "865-687-3632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-25",
        "last_updated": "2015-03-17",
        "status": "A",
        "authorized_official_last_name": "BULL",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "865-687-3622",
        "authorized_official_credential": "APRN, FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521139",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corryton, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; 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.