Provider Demographics
NPI:1669424685
Name:GREENEVILLE URGENT CARE CENTER INC
Entity type:Organization
Organization Name:GREENEVILLE URGENT CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:423-639-3151
Mailing Address - Street 1:1744 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4278
Mailing Address - Country:US
Mailing Address - Phone:423-636-8891
Mailing Address - Fax:
Practice Address - Street 1:1744 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4278
Practice Address - Country:US
Practice Address - Phone:423-636-8891
Practice Address - Fax:423-636-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCB8650OtherRAILROAD MEDICARE
TNTN0100OtherJOHN DEERE HEALTHCARE
TN3707476Medicaid
TN3707476Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER