Provider Demographics
NPI:1699919399
Name:IMMEDIATE CARE CLINIC, PLLC
Entity type:Organization
Organization Name:IMMEDIATE CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:PHILIPOSE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:1502-417-4956
Mailing Address - Street 1:1303 N MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2331
Mailing Address - Country:US
Mailing Address - Phone:931-685-0072
Mailing Address - Fax:931-685-0074
Practice Address - Street 1:1303 N MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2331
Practice Address - Country:US
Practice Address - Phone:931-685-0072
Practice Address - Fax:931-685-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13535261Q00000X, 261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care