MEDICARE: CARESPOT OF LEBANON 1705 WEST MAIN STREET 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	:	1417390642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESPOT OF LEBANON 1705 WEST MAIN STREET LLC

Provider Business Mailing Address
First Line	:	PO BOX 742535
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2535
Country	:	US
Telephone Number	:	972-745-7500
Fax Number	:	972-745-4336

Provider Business Practice Location Address
First Line	:	1705 W MAIN ST
Second Line	:	SUITE 211
City	:	LEBANON
State	:	TN
Zip	:	37087-3193
Country	:	US
Telephone Number	:	615-938-7171
Fax Number	:	615-466-9399

Authorized Official
Title or Position	:	AVP REVENUE CYCLE URGENT CARE
Name	:	MRS. RHONDA MCKINNEY
Credential	:
Telephone Number	:	972-906-8162

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	01/26/2017

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