Provider Demographics
NPI:1235130816
Name:PRI-MED INCORPORATED
Entity type:Organization
Organization Name:PRI-MED INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGEER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-624-5911
Mailing Address - Street 1:1918 EXETER RD
Mailing Address - Street 2:STE-2
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2970
Mailing Address - Country:US
Mailing Address - Phone:901-624-5911
Mailing Address - Fax:901-624-5637
Practice Address - Street 1:1918 EXETER RD
Practice Address - Street 2:STE-2
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2970
Practice Address - Country:US
Practice Address - Phone:901-624-5911
Practice Address - Fax:901-624-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN158399OtherBETTER HEALTH PLAN
TN32656OtherTLC FAMILY HEALTH PLANS
AR99663OtherBCBS-AR
TN4087579OtherBCBS-TN
TN1454502Medicaid
TN5128520001Medicare ID - Type Unspecified