Provider Demographics
NPI:1629381090
Name:MD EXPRESS URGENT CARE
Entity Type:Organization
Organization Name:MD EXPRESS URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICKEY
Authorized Official - Last Name:MAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:865-429-0260
Mailing Address - Street 1:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37868-1548
Mailing Address - Country:US
Mailing Address - Phone:865-429-0260
Mailing Address - Fax:865-429-0202
Practice Address - Street 1:1548 PARKWAY STE 201
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-4020
Practice Address - Country:US
Practice Address - Phone:865-429-0260
Practice Address - Fax:865-429-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16795261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care