MEDICARE: SPRING CITY WALK IN MEDICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	44-3943	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	443943	OTHER	TN	RURAL HEALTH CLINIC

General Provider Information

NPI Number	:	1063433704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING CITY WALK IN MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 709
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-0709
Country	:	US
Telephone Number	:	423-452-9980
Fax Number	:	423-452-9980

Provider Business Practice Location Address
First Line	:	126 LAVENDER ST
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5102
Country	:	US
Telephone Number	:	423-452-9984
Fax Number	:	423-452-9980

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DORIS ELIZABETH YOUNG
Credential	:
Telephone Number	:	423-452-9984

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	02/09/2021

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