Provider Demographics
NPI:1326768870
Name:MADISONVILLE PRIMARY CARE GROUP PLLC
Entity type:Organization
Organization Name:MADISONVILLE PRIMARY CARE GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:423-442-2121
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-0808
Mailing Address - Country:US
Mailing Address - Phone:865-224-7172
Mailing Address - Fax:865-224-7171
Practice Address - Street 1:401 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3468
Practice Address - Country:US
Practice Address - Phone:423-745-6610
Practice Address - Fax:423-745-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care