Provider Demographics
NPI:1104915982
Name:PRIMEHEALTH MEDICAL CENTER, PC
Entity type:Organization
Organization Name:PRIMEHEALTH MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLU
Authorized Official - Middle Name:
Authorized Official - Last Name:FALEYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-372-5260
Mailing Address - Street 1:6637 SUMMER KNOLL CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2875
Mailing Address - Country:US
Mailing Address - Phone:901-372-5260
Mailing Address - Fax:901-386-8726
Practice Address - Street 1:6637 SUMMER KNOLL CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2875
Practice Address - Country:US
Practice Address - Phone:901-372-5260
Practice Address - Fax:901-386-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDF3383Medicare PIN
TN3723194Medicare PIN