Healthcare Provider Details

I. General information

NPI: 1649209396
Provider Name (Legal Business Name): IMMEDIATE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 EUCLID AVE SUITE E17
BRISTOL VA
24201-3834
US

IV. Provider business mailing address

135 W RAVINE RD SUITE 3B
KINGSPORT TN
37660-3847
US

V. Phone/Fax

Practice location:
  • Phone: 276-669-8707
  • Fax: 276-669-9312
Mailing address:
  • Phone: 423-578-4379
  • Fax: 423-578-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number493860
License Number StateVA

VIII. Authorized Official

Name: JOHN T WILLIAMS
Title or Position: MANAGING MEMBER
Credential:
Phone: 423-578-4379