Provider Demographics
NPI:1497557441
Name:KINGSTON URGENT CARE AND FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:KINGSTON URGENT CARE AND FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURUGESEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANDAPANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-617-8579
Mailing Address - Street 1:103 DOVER LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-8794
Mailing Address - Country:US
Mailing Address - Phone:865-617-8579
Mailing Address - Fax:
Practice Address - Street 1:320 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2743
Practice Address - Country:US
Practice Address - Phone:865-617-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty