Organization
PREMIER FAMILY HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA K GORE NP (OWNER)
(931) 392-4169
Entity
Organization
Contact information
Practice address
504 N JACKSON ST STE 103, TULLAHOMA, TN 37388-3520
(931) 841-3821
(931) 841-3869
Mailing address
5833 AEDC RD, ESTILL SPRINGS, TN 37330-3915
(931) 392-4169
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
APN08403
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510611
—
TN
05
—
39293821
—
TN
01
—
4176719
BLUE CROSS
TN
01
—
D02233
RR MC
TN
Enumeration date
04/17/2008
Last updated
02/05/2014
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