Provider Demographics
NPI:1386924686
Name:UCSC PRIMARY CARE - UNION COUNTY LLC
Entity type:Organization
Organization Name:UCSC PRIMARY CARE - UNION COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-951-2012
Mailing Address - Street 1:598 JOHN DEERE DR
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3212
Mailing Address - Country:US
Mailing Address - Phone:865-951-2012
Mailing Address - Fax:865-951-2575
Practice Address - Street 1:598 JOHN DEERE DR
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3212
Practice Address - Country:US
Practice Address - Phone:865-951-2012
Practice Address - Fax:865-951-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36206171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty