Healthcare Provider Details

I. General information

NPI: 1811724743
Provider Name (Legal Business Name): EVANS URGENT CARE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 11/14/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAIN ST STE B
MONTICELLO MS
39654-3702
US

IV. Provider business mailing address

1787 F E SELLERS HWY
MONTICELLO MS
39654-9596
US

V. Phone/Fax

Practice location:
  • Phone: 601-455-5579
  • Fax:
Mailing address:
  • Phone: 601-455-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBIN CATCHINGS-EVANS
Title or Position: OWNER
Credential:
Phone: 601-455-5579