Provider Demographics
NPI:1679951065
Name:IMED URGENT CARE
Entity type:Organization
Organization Name:IMED URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-452-5901
Mailing Address - Street 1:PO BOX 1075
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1075
Mailing Address - Country:US
Mailing Address - Phone:615-452-5901
Mailing Address - Fax:615-250-7900
Practice Address - Street 1:940 MEMORY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-7161
Practice Address - Country:US
Practice Address - Phone:615-452-5901
Practice Address - Fax:615-250-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029196207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty