Healthcare Provider Details

I. General information

NPI: 1427831759
Provider Name (Legal Business Name): URGENT CARE SERVICES SOUTHEAST, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N RACE ST
GLASGOW KY
42141-3454
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY STE 203
KNOXVILLE TN
37919-4052
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-4444
  • Fax:
Mailing address:
  • Phone: 865-985-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN MELISSA TIBEDO
Title or Position: NATIONAL PE DIRECTOR
Credential:
Phone: 865-985-7130