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General NPI Number Information
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NPI Number | 1699919399
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Entity Type | Organization
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Legal Business Name | IMMEDIATE CARE CLINIC, PLLC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 1303 N MAIN ST STE C
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2331
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Country | US
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Telephone | 931-685-0072
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Fax | 931-685-0074
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Provider Business Mailing Address
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Address Line | 1303 N MAIN ST STE C
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2331
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Country | US
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Telephone | 931-685-0072
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Fax | 931-685-0074
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. ANITA SUSAN PHILIPOSE
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Credential | ARNP
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Telephone | 15024174956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 13535
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 13535
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 13535
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License Number State | TN
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