Provider Demographics
NPI:1134787823
Name:METRO URGENT CARE AT DIXIE, LLC
Entity type:Organization
Organization Name:METRO URGENT CARE AT DIXIE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-919-9009
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:EASTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40018-0066
Mailing Address - Country:US
Mailing Address - Phone:502-919-9009
Mailing Address - Fax:502-919-9008
Practice Address - Street 1:4500 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2875
Practice Address - Country:US
Practice Address - Phone:502-919-9009
Practice Address - Fax:502-919-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care