MEDICARE: GOLDEN TRIANGLE URGENT CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	261Q00000X	Clinic/Center
3	261QU0200X	Urgent Care Clinic/Center
4	363LF0000X	Family Nurse Practitioner
5	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1104559806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN TRIANGLE URGENT CARE LLC

Provider Business Mailing Address
First Line	:	30 BURTON HILLS BLVD STE 175
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6403
Country	:	US
Telephone Number	:	615-864-8709
Fax Number	:	615-301-6558

Provider Business Practice Location Address
First Line	:	7474 HIGHWAY 45 ALT N
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-7981
Country	:	US
Telephone Number	:	662-494-5863
Fax Number	:	662-494-5287

Authorized Official
Title or Position	:	CONTROLLER
Name	:	STEPHANIE HICKS
Credential	:
Telephone Number	:	615-988-2004

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	03/26/2025

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