Provider Demographics
NPI:1083019608
Name:COMMUNITY QUICK CARE
Entity Type:Organization
Organization Name:COMMUNITY QUICK CARE
Other - Org Name:COMMUNITY QUICK CARE OF COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:931-490-0832
Mailing Address - Street 1:1412 TROT AVENUE
Mailing Address - Street 2:SUITE 39
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-490-0832
Mailing Address - Fax:931-490-0834
Practice Address - Street 1:1412 TROTWOOD AVENUE
Practice Address - Street 2:SUITE 39
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-490-0832
Practice Address - Fax:931-490-0834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY QUICK CARE OF LAVERGNE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11494332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site