Provider Demographics
NPI:1154539591
Name:PRIMARY HEALTHCARE GROUP INC
Entity type:Organization
Organization Name:PRIMARY HEALTHCARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALLOU
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:615-688-2273
Mailing Address - Street 1:200 HIGHWAY 52 BYP W
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1727
Mailing Address - Country:US
Mailing Address - Phone:615-688-2273
Mailing Address - Fax:615-688-2271
Practice Address - Street 1:200 HIGHWAY 52 BYP W
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1727
Practice Address - Country:US
Practice Address - Phone:615-688-2273
Practice Address - Fax:615-688-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372555Medicare PIN
TN3372555Medicare ID - Type Unspecified