| Prime Medical Group, Pc | |
|
6005 Park Ave Suite 433b Memphis TN 38119-5202 | |
| (901) 255-1140 | |
| Not Available |
| Full Name | Prime Medical Group, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6005 Park Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Taslim A Khattak (PRESIDENT) |
| Authorized Official Contact | 9012551140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Medical Group, Pc 6005 Park Ave Ste 433b Memphis TN 38119-5211 Ph: (901) 255-1140 | Prime Medical Group, Pc 6005 Park Ave Suite 433b Memphis TN 38119-5202 Ph: (901) 255-1140 |
| NPI Number | 1073624144 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 05/02/2019 |
| Medicare PECOS PAC ID | 6800078429 |
|---|---|
| Medicare Enrollment ID | O20110303000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073624144 | NPI | - | NPPES |
| 3724095 | Medicaid | TN | |
| 09016225 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Taslim Khattak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679540298 PECOS PAC ID: 8729147400 Enrollment ID: I20081110000777 |
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