Provider Demographics
NPI:1891861159
Name:THERESA BUCK'S URGENT CARE WALK IN CLINIC
Entity Type:Organization
Organization Name:THERESA BUCK'S URGENT CARE WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-507-9355
Mailing Address - Street 1:1100 SMITHVILLE HWY STE 123
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1665
Mailing Address - Country:US
Mailing Address - Phone:931-507-9355
Mailing Address - Fax:931-507-9355
Practice Address - Street 1:1100 SMITHVILLE HWY STE 123
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1665
Practice Address - Country:US
Practice Address - Phone:931-507-9355
Practice Address - Fax:931-507-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4067700Medicaid
TN4067700Medicaid
TNP53121Medicare UPIN