Healthcare Provider Details

I. General information

NPI: 1144876590
Provider Name (Legal Business Name): MOUNTAIN PARK URGENT CARE & WALK-IN CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 E MAIN ST STE 2
SYLVA NC
28779-3030
US

IV. Provider business mailing address

PO BOX 1039
SYLVA NC
28779-1039
US

V. Phone/Fax

Practice location:
  • Phone: 770-265-8506
  • Fax:
Mailing address:
  • Phone: 828-631-3181
  • Fax: 828-631-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LAURA SOUTHERN MILLER
Title or Position: ORGANIZER
Credential: NP
Phone: 770-265-8506