NPIMap

Hometown Urgent Care of Dyersburg PLLC

Organization Active NPI Urgent Care Clinic/Center · Dyersburg, TN

NPI 1003318593 · NPPES record last updated May 25, 2018

Key facts

NPI
1003318593
Entity type
Organization (NPI type 2)
Primary specialty
Urgent Care Clinic/Center 261QU0200X
Legal business name
HOMETOWN URGENT CARE OF DYERSBURG PLLC
Practice address
2550 Parr Ave
Dyersburg, TN 38024
Phone
(731) 325-5678
NPI assigned
Mar 1, 2018
Organization subpart
No

Authorized official

Name
Mohsin Alhaddad, MD NPI 1467624619
Title
Provider
Phone
(731) 325-5678

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2133677Hometown Urgent Care of Dyersburg, PLLC
2550 Parr Avenue, Dyersburg, TN 38024		Certificate of waiverApr 5, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TN, MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20180924003434 TN Part B Supplier - Clinic/Group Practice 8820349202 Receives reassigned benefits from 24 practitioners
Practice locations: Dyersburg, TN
O20200610002833 MO Part B Supplier - Clinic/Group Practice 8820349202 Receives reassigned benefits from 1 practitioner
Practice locations: Hayti, MO; Kennett, MO

National Provider Directory

Locations

946 E Reed St
Hayti, MO 63851
Phone (573) 359-3408

2550 Parr Ave
Dyersburg, TN 38024
Phone (731) 325-5678

327 Summar Dr
Jackson, TN 38301
Phone (731) 325-5678

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X Yes

Addresses

Primary practice location

2550 Parr Ave
Dyersburg, TN 38024

Mailing address

2550 Parr Ave
Dyersburg, TN 38024-2033
Phone (731) 325-5678

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 25, 2018.

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527206400000",
    "number": "1003318593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 PARR AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242033",
            "telephone_number": "731-325-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 PARR AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-325-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN URGENT CARE OF DYERSBURG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2018-05-25",
        "status": "A",
        "authorized_official_last_name": "ALHADDAD",
        "authorized_official_first_name": "MOHSIN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "731-325-5678",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyersburg, TN

All providers in Dyersburg, TN · Urgent Care Clinic/Center in Tennessee

Sources for this page

Verify at the official NPI Registry.