MEDICARE: HN UCC 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1093308504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HN UCC LLC

Provider Business Mailing Address
First Line	:	3048 S ATLANTIC AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118-6102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3048 S ATLANTIC AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118-6102
Country	:	US
Telephone Number	:	423-531-1330
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	KATHERINE ELIZABETH PENDERGRASS
Credential	:
Telephone Number	:	423-331-2055

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	04/10/2024

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