Provider Demographics
NPI:1316059405
Name:PHYSICIANS URGENT CARE OF CORINTH, LLC
Entity type:Organization
Organization Name:PHYSICIANS URGENT CARE OF CORINTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-287-7138
Mailing Address - Street 1:2601 GETWELL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6762
Mailing Address - Country:US
Mailing Address - Phone:662-287-7138
Mailing Address - Fax:662-287-7157
Practice Address - Street 1:2601 GETWELL RD STE 1
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6762
Practice Address - Country:US
Practice Address - Phone:662-287-7138
Practice Address - Fax:662-287-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016155Medicaid