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General NPI Number Information
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NPI Number | 1346592045
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Entity Type | Organization
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Legal Business Name | GOLDEN TRIANGLE URGENT CARE LLC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 500 RUSSELL ST STE 3
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City | STARKVILLE
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State | MS
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Zip | 39759-5411
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Country | US
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Telephone | 662-324-2244
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Fax | 662-324-2295
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Provider Business Mailing Address
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Address Line | 30 BURTON HILLS BLVD SUITE 175
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City | NASHVILLE
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State | TN
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Zip | 37215-6403
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Country | US
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Telephone | 615-988-2009
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Fax | 615-250-9773
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Authorized Official
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Title or Position | CFO
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Name | RUDY BLANK
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Credential |
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Telephone | 615-988-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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