Optimum Primary Care PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD0000015018 Issued in TN

Legal business name

OPTIMUM PRIMARY CARE PC

Practice address

444 Clinchfield St
Suite 303
Kingsport, TN 37660-3606

Phone

(423) 914-3195

Fax

(423) 230-2818

NPI assigned

Mar 25, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Mack Lynn Hicks, M.D.NPI 1154354900

Title

Physician

Phone

(423) 914-3195

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Mack L Hicks, MD

  • Family Medicine Physician
  • Kingsport, TN
  • NPI 1154354900
  NPD Authorized official

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1952728289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD ST",
            "address_2": "SUITE 303",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD ST",
            "address_2": "SUITE 303",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603606",
            "telephone_number": "423-914-3195",
            "fax_number": "423-230-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "MACK",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "423-914-3195",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000015018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3024432",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kourtney Kahler Oggero, FNP
• Frank L Oglesby Jr., O.D.
• Tasha Marie Olinger, M.S., CF-SLP
• Amanda Michelle Oliver
• Susan Annette Oliver, LMT
• Shane Michael Orcutt
• Gabriela Paola Orozco, MD
• Emma Jane Orr, PHARM.D.
• April Dawn Osborne, RN
• Trisha Osborne, PHARMD

• Family Medicine Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.