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General NPI Number Information
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NPI Number | 1629381090
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Entity Type | Organization
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Legal Business Name | MD EXPRESS URGENT CARE
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 1548 PARKWAY STE 201
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City | SEVIERVILLE
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State | TN
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Zip | 37862-4020
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Country | US
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Telephone | 865-429-0260
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Fax | 865-429-0202
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Provider Business Mailing Address
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Address Line | PO BOX 1548
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City | PIGEON FORGE
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State | TN
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Zip | 37868-1548
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Country | US
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Telephone | 865-429-0260
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Fax | 865-429-0202
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. ROBERT MICKEY MAUGHON
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Credential | M. D.
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Telephone | 865-429-0260
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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 | MD16795
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License Number State | TN
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