Healthcare Provider Details

I. General information

NPI: 1639403769
Provider Name (Legal Business Name): DR. JON'S URGENT CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2871 GREENSBORO RD
MARTINSVILLE VA
24112-8108
US

IV. Provider business mailing address

2871 GREENSBORO RD
MARTINSVILLE VA
24112-8108
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-2273
  • Fax: 276-638-2250
Mailing address:
  • Phone: 276-638-2273
  • Fax: 276-638-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JON PETERSON
Title or Position: DIRECTOR/OWNER
Credential: MD
Phone: 276-638-2273