Healthcare Provider Details

I. General information

NPI: 1811463185
Provider Name (Legal Business Name): TENNESSEE RIVER URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E 2ND ST STE A
SHEFFIELD AL
35660-3219
US

IV. Provider business mailing address

707 E 2ND ST STE A
SHEFFIELD AL
35660-3219
US

V. Phone/Fax

Practice location:
  • Phone: 256-320-7365
  • Fax: 256-320-7366
Mailing address:
  • Phone: 256-320-7365
  • Fax: 256-320-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTINE E MOLLOHAN
Title or Position: OWNER/NP
Credential:
Phone: 256-320-7365