Provider Demographics
NPI:1164826285
Name:COMMUNITY QUICK CARE
Entity Type:Organization
Organization Name:COMMUNITY QUICK CARE
Other - Org Name:COMMUNITY QUICK CARE OF LEBANON
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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:615-943-5072
Mailing Address - Street 1:1670 W MAIN ST STE 140
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1345
Mailing Address - Country:US
Mailing Address - Phone:615-453-9492
Mailing Address - Fax:615-453-9498
Practice Address - Street 1:1670 W MAIN ST STE 140
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1345
Practice Address - Country:US
Practice Address - Phone:615-453-9492
Practice Address - Fax:615-453-9498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY QUICK CARE OF LAVERGNE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016043332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site