NPIMap

Organization Active NPI

Smoky Mountain Urgent Care PC

Doing business as Smoky Mountain Urgent Care

  • Rural Health Clinic/Center
  • Bryson City, NC
National Provider Identifier
1407428931
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SMOKY MOUNTAIN URGENT CARE PC
Doing business as
Smoky Mountain Urgent Care
Practice address
80 Veterans Blvd
Bryson City, NC 28713-8816
Phone
(828) 538-4546
Fax
(828) 538-4549
NPI assigned
Jul 14, 2021
Last updated
Jul 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Authorized official

Name
David Randall CastorNPI 1073735155
Title
President
Phone
(828) 538-4546

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

80 Veterans Blvd
Bryson City, NC 28713-8816

Mailing address

PO Box 2029
Bryson City, NC 28713-5029

Other names 1

  • Smoky Mountain Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210913002546 NC Part A Provider - Rural Health Clinic 8022242148 Practice locations: Bryson City, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407428931. Details of each certification follow.

Rural health clinic certification: CCN 348969

Legal name
SMOKY MOUNTAIN URGENT CARE PC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 30, 2021
Last certification
Dec 30, 2021
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 30, 2013 in NC
Enrollment address
80 Veterans Blvd
Bryson City, NC 28713-8816

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Smoky Mountain Urgent Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Castor Individual 5% Or Greater Direct Ownership InterestOwner Aug 1, 2021 100%
W-2 Managing EmployeeOwner Aug 1, 2021 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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": "1626220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1407428931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2029",
            "city": "BRYSON CITY",
            "state": "NC",
            "postal_code": "287135029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 VETERANS BLVD",
            "city": "BRYSON CITY",
            "state": "NC",
            "postal_code": "287138816",
            "telephone_number": "828-538-4546",
            "fax_number": "828-538-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMOKY MOUNTAIN URGENT CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "CASTOR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-538-4546"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smoky Mountain Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bryson City, NC

Sources for this page

Verify at the official NPI Registry.