Healthcare Provider Details

I. General information

NPI: 1316124852
Provider Name (Legal Business Name): URGENT CARE CENTERS OF EAST TENNESSEE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 KEITH ST NW
CLEVELAND TN
37312-4341
US

IV. Provider business mailing address

4021 KEITH ST NW
CLEVELAND TN
37312-4341
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-2464
  • Fax: 423-476-1008
Mailing address:
  • Phone: 423-476-2464
  • Fax: 423-478-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHMOOD A SIDDIQUI
Title or Position: PRESIDENT
Credential: MD
Phone: 423-496-9214