MEDICARE: UNION CITY URGENT CARE

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	363A00000X	Physician Assistant	2564	TN

General Provider Information

NPI Number	:	1811306525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION CITY URGENT CARE

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38281
Country	:	US
Telephone Number	:	731-885-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 S 1ST ST
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-5014
Country	:	US
Telephone Number	:	731-885-8282
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	MICHAEL CHAD ODLE
Credential	:
Telephone Number	:	731-885-8282

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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Directions to “UNION CITY URGENT CARE ” Practice Location

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