NPIMap

Organization Active NPI

Spring City Walk in Medical Center, LLC

  • Rural Health Clinic/Center
  • Spring City, TN
National Provider Identifier
1063433704
Registry record updated Feb 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
44-3943 Issued in TN
Legal business name
SPRING CITY WALK IN MEDICAL CENTER, LLC
Practice address
126 Lavender St
Spring City, TN 37381-5102
Phone
(423) 452-9984
Fax
(423) 452-9980
NPI assigned
Jul 21, 2006
Last updated
Feb 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Doris Elizabeth Young
Title
Office Manager
Phone
(423) 452-9984

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 44-3943 TN Primary

Addresses

Primary practice location

126 Lavender St
Spring City, TN 37381-5102

Mailing address

PO Box 709
Spring City, TN 37381-0709
Phone (423) 452-9980

Other identifiers 1

IdentifierTypeStateIssuer
443943OtherTNRURAL HEALTH CLINIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063433704. Details of each certification follow.

Rural health clinic certification: CCN 443943

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SPRING CITY WALK IN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 11, 2004
Last certification
Oct 25, 2016
Ownership / control type
2A
Facility address
126 Lavender Street
Spring City, TN 37381

National Provider Directory

National Provider Directory

Locations

126 Lavender St
Spring City, TN 37381
Phone (423) 365-0450

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1063433704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 709",
            "city": "SPRING CITY",
            "state": "TN",
            "postal_code": "373810709",
            "telephone_number": "423-452-9980",
            "fax_number": "423-452-9980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 LAVENDER ST",
            "city": "SPRING CITY",
            "state": "TN",
            "postal_code": "373815102",
            "telephone_number": "423-452-9984",
            "fax_number": "423-452-9980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING CITY WALK IN MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "DORIS",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-452-9984"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": "44-3943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH CLINIC",
            "identifier": "443943",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring City, TN

Sources for this page

Verify at the official NPI Registry.