Provider Demographics
NPI:1952075335
Name:SMOKY MOUNTAIN URGENT CARE PC
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-538-4546
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-5029
Mailing Address - Country:US
Mailing Address - Phone:828-538-4556
Mailing Address - Fax:
Practice Address - Street 1:120 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-8817
Practice Address - Country:US
Practice Address - Phone:828-488-1974
Practice Address - Fax:828-488-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health