Provider Demographics
NPI:1649851163
Name:LEGACY URGENT CARE
Entity type:Organization
Organization Name:LEGACY URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIASCHIA
Authorized Official - Middle Name:BRYANNA
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:931-334-3211
Mailing Address - Street 1:479 W SAM RIDLEY PKWY STE 105-301
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6486
Mailing Address - Country:US
Mailing Address - Phone:931-334-3211
Mailing Address - Fax:
Practice Address - Street 1:7022 SILVER FOX ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-1097
Practice Address - Country:US
Practice Address - Phone:931-334-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care