MEDICARE: COMMON ILLNESS CLINIC 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	:	1538220496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMON ILLNESS CLINIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 3240
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320-3240
Country	:	US
Telephone Number	:	423-476-7947
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 SPRING PLACE RD SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-3337
Country	:	US
Telephone Number	:	423-614-4780
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BRIAN G SCOGGINS
Credential	:
Telephone Number	:	423-322-4553

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/10/2007

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