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1346854064 NPI number — JACKSBORO URGENT CARE LLC

NPI Number: 1346854064
Health Care Provider/Practitioner: JACKSBORO URGENT CARE LLC

Information about “1346854064” NPI (JACKSBORO URGENT CARE LLC) exists in 1346854064 in HTML format HTML  |  1346854064 in plain Text format TXT  |  1346854064 in PDF (Portable Document Format) PDF  |  1346854064 in an XML format XML  formats.

NPI Number : 1346854064 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346854064",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "JACKSBORO URGENT CARE LLC",
    "ParentOrgTIN": null,
    "OrgName": "JACKSBORO URGENT CARE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2707 JACKSBORO PIKE STE 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSBORO",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37757-2752",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-437-8576",
    "MailingAddressFaxNumber": "423-437-8556",
    "FirstLinePracticeLocationAddress": "2130 N CHARLES G SEIVERS BLVD STE 3",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLINTON",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37716-6705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-437-8576",
    "PracticeLocationAddressFaxNumber": "423-437-8556",
    "EnumerationDate": "09/01/2020",
    "LastUpdateDate": "07/25/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EBERHARTER",
    "AuthorizedOfficialFirstName": "PATRICIA",
    "AuthorizedOfficialMiddleName": "ANN",
    "AuthorizedOfficialTitle": "CHIEF OFFICER/OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "423-907-8186",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QU0200X",
        "TaxonomyName": "Urgent Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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