Organization Name: | FOUNDATION PRIMARY CARE, LLC |
NPI Number: | 1801190921 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM BREEN (PRESIDENT) |
Mailing Address: | 7690 Wolf River Cir Germantown |
State: | TN US |
Postal Code: | 381381744 |
Phone Number: | 9017561231 |
Fax Number: | 9017551590 |
NPI Enumeration Date: | 01/04/2011 |
NPI Last Update Date: | 01/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |