NPIMap

Organization Active NPI

Jacksboro Urgent Care

  • Urgent Care Clinic/Center
  • Jacksboro, TN
National Provider Identifier
1629536362
Registry record updated Mar 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
JACKSBORO URGENT CARE
Practice address
2707 Jacksboro Pike
Suite 2
Jacksboro, TN 37757
Phone
(423) 907-8186
Fax
(423) 907-8187
NPI assigned
Mar 12, 2019
Last updated
Mar 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2019

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

Authorized official

Name
Mrs. Patricia Eberharter, FNP-BCNPI 1841514957
Title
Chief Officer/Owner
Phone
(423) 907-8186

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

2707 Jacksboro Pike
Suite 2
Jacksboro, TN 37757

Mailing address

2707 Jacksboro Pike
Suite 2
Jacksboro, TN 37757
Phone (423) 907-8186

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190521002443 TN Part B Supplier - Clinic/Group Practice 4385987098 Receives reassigned benefits from 9 practitioners
Practice locations: Jacksboro, TN

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2165759Jacksboro Urgent Care2707 Jacksboro Pike Ste 2, Jacksboro, TN 37757Certificate of waiverMay 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Jacksboro Urgent Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2707 Jacksboro Pike
Jacksboro, TN 37757

2707 Jacksboro Pike
Ste 2
Jacksboro, TN 37757
Phone (423) 437-8576

304 E Central Ave
La Follette, TN 37766
Phone (423) 437-8612

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

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": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1629536362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 JACKSBORO PIKE",
            "address_2": "SUITE 2",
            "city": "JACKSBORO",
            "state": "TN",
            "postal_code": "37757",
            "telephone_number": "423-907-8186",
            "fax_number": "423-907-8187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 JACKSBORO PIKE",
            "address_2": "SUITE 2",
            "city": "JACKSBORO",
            "state": "TN",
            "postal_code": "37757",
            "telephone_number": "423-907-8186",
            "fax_number": "423-907-8187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSBORO URGENT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "EBERHARTER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CHIEF OFFICER/OWNER",
        "authorized_official_telephone_number": "423-907-8186",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksboro, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.