Healthcare Provider Details

I. General information

NPI: 1437650751
Provider Name (Legal Business Name): T & L QUICK CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 29TH ST SE
WATERTOWN SD
57201-9120
US

IV. Provider business mailing address

1056 29TH ST SE
WATERTOWN SD
57201-9120
US

V. Phone/Fax

Practice location:
  • Phone: 605-753-0960
  • Fax:
Mailing address:
  • Phone: 605-753-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HOLLY GISI-YORK
Title or Position: OWNER
Credential: C-NP
Phone: 605-881-0432