Provider Demographics
NPI:1346854064
Name:JACKSBORO URGENT CARE
Entity Type:Organization
Organization Name:JACKSBORO URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EBERHARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-907-8186
Mailing Address - Street 1:2707 JACKSBORO PIKE STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2752
Mailing Address - Country:US
Mailing Address - Phone:423-437-8576
Mailing Address - Fax:423-437-8556
Practice Address - Street 1:2130 N CHARLES G SEIVERS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6705
Practice Address - Country:US
Practice Address - Phone:423-437-8576
Practice Address - Fax:423-437-8556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSBORO URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care