Provider Demographics
NPI:1609158120
Name:URGENT CARE OF ERWIN, LLC
Entity Type:Organization
Organization Name:URGENT CARE OF ERWIN, LLC
Other - Org Name:BOONES CREEK URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:DEBORD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:276-685-6492
Mailing Address - Street 1:800 S MOHAWK DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-2124
Mailing Address - Country:US
Mailing Address - Phone:423-330-6177
Mailing Address - Fax:423-330-6241
Practice Address - Street 1:800 S MOHAWK DR
Practice Address - Street 2:SUITE E
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2124
Practice Address - Country:US
Practice Address - Phone:423-735-0500
Practice Address - Fax:423-735-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty