OrganizationOptimum Primary Care PcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address444 Clinchfield St, Suite 303, Kingsport, TN 37660-3606(423) 914-3195PECOS EnrollmentBased on the most recent information from CMS, provider Optimum Primary Care Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 4:18 PM.Profile DetailsProvider ID1952728289Provider TypeOrganizationFull NameOptimum Primary Care PcSubpartNoEnumeration Date3/25/2014Last Updated3/25/2014Contact InformationPractice LocationPractice Address444 Clinchfield St, Suite 303, Kingsport, TN 37660-3606Phone(423) 914-3195Fax(423) 230-2818Mailing LocationMailing Address444 Clinchfield St, Suite 303, Kingsport, TN 37660-3606PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameHicks, Mack Lynn (Physician)Phone(423) 914-3195Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMD0000015018TennesseeProvider IdentifiersIDDescriptionIssuerID3024432DescriptionMedicaidIssuerUnlistedTennessee