Organization Name: | PRODIGAL PRIMARY CARE PC |
NPI Number: | 1306196530 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID E BRICKHOUSE (OWNER) |
Mailing Address: | 721 Highway 321 N Bld 3 Lenoir City |
State: | TN US |
Postal Code: | 377715003 |
Phone Number: | 8652883754 |
Fax Number: | 8653946719 |
NPI Enumeration Date: | 09/14/2012 |
NPI Last Update Date: | 11/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |