Provider Demographics
NPI:1649209396
Name:IMMEDIATE CARE, LLC
Entity Type:Organization
Organization Name:IMMEDIATE CARE, LLC
Other - Org Name:MED EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-578-4379
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-578-4379
Mailing Address - Fax:423-578-4369
Practice Address - Street 1:1315 EUCLID AVE
Practice Address - Street 2:SUITE E17
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3834
Practice Address - Country:US
Practice Address - Phone:276-669-8707
Practice Address - Fax:276-669-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA493860261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
493860Medicare ID - Type Unspecified