Provider Demographics
NPI:1902619661
Name:LUNCEFORD PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:LUNCEFORD PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:LUNCEFORD-LEVESQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:615-878-1533
Mailing Address - Street 1:4777 ANDREW JACKSON PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1356
Mailing Address - Country:US
Mailing Address - Phone:615-889-7010
Mailing Address - Fax:615-889-0135
Practice Address - Street 1:4777 ANDREW JACKSON PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1356
Practice Address - Country:US
Practice Address - Phone:615-889-7010
Practice Address - Fax:615-889-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty