NPIMap

Organization Active NPI

Urgent Care of Erwin, LLC

Doing business as Boones Creek Urgent Care

  • Urgent Care Clinic/Center
  • Erwin, TN
National Provider Identifier
1609158120
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
URGENT CARE OF ERWIN, LLC
Doing business as
Boones Creek Urgent Care
Urgent Care of Erwin
Practice address
800 S Mohawk Dr
Suite E
Erwin, TN 37650-2124
Phone
(423) 735-0500
Fax
(423) 735-0499
NPI assigned
Sep 10, 2011
Last updated
May 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Authorized official

Name
Harold Lance Debord, PA-CNPI 1366413874
Title
Managing Member
Phone
(276) 685-6492

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
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

800 S Mohawk Dr
Suite E
Erwin, TN 37650-2124

Mailing address

800 S Mohawk Dr
Suite E
Erwin, TN 37650-2124
Phone (423) 330-6177

Other practice location 1

4100 N Roan St Ste 3
Johnson City, TN 37601-1134
Phone (423) 268-2606

Other names 2

  • Boones Creek Urgent Care Doing business as
  • Urgent Care of Erwin Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111024000623 TN Part B Supplier - Clinic/Group Practice 2860665635 Receives reassigned benefits from 7 practitioners
Practice locations: Erwin, TN; Johnson City, TN

National Provider Directory

National Provider Directory

Locations

4100 N Roan St
Ste 3
Johnson City, TN 37601
Phone (423) 268-2606

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/4824/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 7

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": "1315612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1609158120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S MOHAWK DR",
            "address_2": "SUITE E",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502124",
            "telephone_number": "423-330-6177",
            "fax_number": "423-330-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S MOHAWK DR",
            "address_2": "SUITE E",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376502124",
            "telephone_number": "423-735-0500",
            "fax_number": "423-735-0499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 N Roan St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376011134",
            "country_code": "US",
            "telephone_number": "423-268-2606",
            "fax_number": "423-268-2608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "URGENT CARE OF ERWIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-10",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "DEBORD",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "LANCE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "276-685-6492",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boones Creek Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Urgent Care of Erwin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erwin, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.