Provider Demographics
NPI:1689603474
Name:OLIVER SPRINGS WALK-IN MEDICAL CENTER
Entity Type:Organization
Organization Name:OLIVER SPRINGS WALK-IN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-922-1400
Mailing Address - Street 1:616 E TRI COUNTY BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-5413
Mailing Address - Country:US
Mailing Address - Phone:865-922-1400
Mailing Address - Fax:
Practice Address - Street 1:616 E TRI COUNTY BLVD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-5413
Practice Address - Country:US
Practice Address - Phone:865-922-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000011610261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB03239Medicare UPIN
TN3728468Medicare ID - Type Unspecified