Healthcare Provider Details

I. General information

NPI: 1639310923
Provider Name (Legal Business Name): PCL EXPRESS WALK-IN CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 1ST AVE N
LEWISBURG TN
37091-2826
US

IV. Provider business mailing address

335 1ST AVE N
LEWISBURG TN
37091-2826
US

V. Phone/Fax

Practice location:
  • Phone: 931-270-0050
  • Fax: 931-270-0052
Mailing address:
  • Phone:
  • Fax:

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: ERIN L WHITE
Title or Position: OWNER
Credential: NP
Phone: 931-270-0050