MEDICARE: METRO URGENT CARE AT DIXIE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1134787823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO URGENT CARE AT DIXIE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	EASTWOOD
State	:	KY
Zip	:	40018-0066
Country	:	US
Telephone Number	:	502-919-9009
Fax Number	:	502-919-9008

Provider Business Practice Location Address
First Line	:	4500 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-2875
Country	:	US
Telephone Number	:	502-919-9009
Fax Number	:	502-919-9008

Authorized Official
Title or Position	:	OWNER
Name	:	ABDUL HAQ
Credential	:
Telephone Number	:	502-919-9009

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	09/30/2019

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