Provider Demographics
NPI:1396173423
Name:ROANE URGENT CARE CLINIC LLC
Entity type:Organization
Organization Name:ROANE URGENT CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-255-3310
Mailing Address - Street 1:2497 S. ROANE ST
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748
Mailing Address - Country:US
Mailing Address - Phone:865-255-3310
Mailing Address - Fax:865-590-0196
Practice Address - Street 1:2497 S. ROANE ST
Practice Address - Street 2:SUITE 110 B
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748
Practice Address - Country:US
Practice Address - Phone:865-255-3310
Practice Address - Fax:865-590-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1295167351OtherPERSONAL NPI