Healthcare Provider Details

I. General information

NPI: 1730590324
Provider Name (Legal Business Name): URGENT CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8861 KINGSTON PIKE
KNOXVILLE TN
37923-5002
US

IV. Provider business mailing address

8861 KINGSTON PIKE
KNOXVILLE TN
37923-5002
US

V. Phone/Fax

Practice location:
  • Phone: 865-281-5415
  • Fax: 865-281-5337
Mailing address:
  • Phone: 865-281-5415
  • Fax: 865-281-5337

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 Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1728
License Number StateTN

VIII. Authorized Official

Name: JERRY KEITH GOUGE
Title or Position: OWNER
Credential: P.A.
Phone: 865-414-9346