Provider Demographics
NPI:1144876590
Name:MOUNTAIN PARK URGENT CARE & WALK-IN CLINIC, PLLC
Entity type:Organization
Organization Name:MOUNTAIN PARK URGENT CARE & WALK-IN CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SOUTHERN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-265-8506
Mailing Address - Street 1:PO BOX 1039
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-1039
Mailing Address - Country:US
Mailing Address - Phone:828-631-3181
Mailing Address - Fax:828-631-6113
Practice Address - Street 1:90 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-3030
Practice Address - Country:US
Practice Address - Phone:770-265-8506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care