Provider Demographics
NPI:1245465517
Name:PRIMARY HEALTHCARE MANAGEMENT LLC
Entity type:Organization
Organization Name:PRIMARY HEALTHCARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-679-9671
Mailing Address - Street 1:648 RIVERSIDE DR APT 210
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4620
Mailing Address - Country:US
Mailing Address - Phone:901-679-9671
Mailing Address - Fax:
Practice Address - Street 1:648 RIVERSIDE DR APT 210
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4620
Practice Address - Country:US
Practice Address - Phone:901-679-9671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty