Provider Demographics
NPI:1528055621
Name:TENET UNIFOUR URGENT CARE CENTER LLC
Entity type:Organization
Organization Name:TENET UNIFOUR URGENT CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP OF OUTPATIENT SERVICES, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:P.O. BOX 741330
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1330
Mailing Address - Country:US
Mailing Address - Phone:828-267-0551
Mailing Address - Fax:828-267-0351
Practice Address - Street 1:1105 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9090
Practice Address - Country:US
Practice Address - Phone:828-267-0551
Practice Address - Fax:828-267-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01766OtherBCBS
CG6339OtherRAILROAD MEDICARE
NC89011F3Medicaid
CG6339Medicare PIN
NC89011F3Medicaid