Provider Demographics
NPI:1790045656
Name:MD EXPRESS URGENT CARE PLLC
Entity Type:Organization
Organization Name:MD EXPRESS URGENT CARE PLLC
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:M
Authorized Official - Last Name:MAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-429-0208
Mailing Address - Street 1:PO BOX 1518
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37868-1518
Mailing Address - Country:US
Mailing Address - Phone:865-429-0208
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:865-429-0208
Practice Address - Fax:865-429-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16795261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care