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General NPI Number Information
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NPI Number | 1427155043
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Entity Type | Organization
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Legal Business Name | NORTHSIDE URGENT CARE INC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1701 N MAIN ST SUITE E
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2303
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Country | US
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Telephone | 931-684-1990
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Fax | 931-680-5602
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Provider Business Mailing Address
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Address Line | 1701 N MAIN ST SUITE E
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2303
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Country | US
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Telephone | 931-684-1990
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Fax | 931-680-5602
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK L JAYAKODY
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Credential | MD
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Telephone | 931-684-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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