Healthcare Provider Details

I. General information

NPI: 1346854064
Provider Name (Legal Business Name): JACKSBORO URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 N CHARLES G SEIVERS BLVD STE 3
CLINTON TN
37716-6705
US

IV. Provider business mailing address

2707 JACKSBORO PIKE STE 2
JACKSBORO TN
37757-2752
US

V. Phone/Fax

Practice location:
  • Phone: 423-437-8576
  • Fax: 423-437-8556
Mailing address:
  • Phone: 423-437-8576
  • Fax: 423-437-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICIA ANN EBERHARTER
Title or Position: CHIEF OFFICER/OWNER
Credential:
Phone: 423-907-8186