Ultra Health Lebanon
Organization Active NPI Rural Health Clinic/Center · Lebanon, VA
NPI 1689534802 · NPPES record last updated Nov 12, 2025
Key facts
- NPI
- 1689534802
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ULTRA HEALTH LEBANON
- Practice address
- 39 S Flannagan Ave
Lebanon, VA 24266-4575 - Phone
- (276) 883-5308
- NPI assigned
- Nov 12, 2025
- Organization subpart
- Yes
- Parent organization (as reported)
- TOWN CENTER URGENT CARE LLC
Authorized official
- Name
- Kayla Briana Cline
- Title
- Ao
- Phone
- (276) 385-1183
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Rural health clinic certification: CCN 493875
- Legal name
- TOWN CENTER URGENT CARE LLC
- Doing business as
- ULTRA HEALTH LEBANON
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 14, 2025
- Last certification
- May 14, 2025
- Ownership / control type
- 1A
- Organization structure
- LLC · Proprietary
- Enrollment address
- 39 S Flannagan Ave
Lebanon, VA 24266-4575
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Jeffery H Taylor |
5% Or Greater Direct Ownership Interest | Jan 1, 2023 | 50% |
| Corporate Officer |
Jan 1, 2023 | 50% | |
| Operational/Managerial Control | Jan 1, 2023 | 100% | |
| Ultra Health Services LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2023 | 100% |
| Operational/Managerial Control | Jan 1, 2023 | 100% | |
| Stanford T Mullins |
5% Or Greater Direct Ownership Interest | Jan 1, 2023 | 50% |
| Corporate Officer |
Jan 1, 2023 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250425001762 | VA | Part a Provider - Rural Health Clinic | 0547529547 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lebanon, VA |
National Provider Directory
- Tax ID family
- Town Center Urgent Care LLC
- Part of
- Town Center Urgent Care LLC
Locations
39 S Flannagan Ave
Lebanon, VA 24266
Phone (276) 385-1183
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
39 S Flannagan Ave
Lebanon, VA 24266-4575
Mailing address
39 S Flannagan Ave
Lebanon, VA 24266-4575
NPI Registry JSON
{
"created_epoch": "1762905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1762905600000",
"number": "1689534802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 S FLANNAGAN AVE",
"city": "LEBANON",
"state": "VA",
"postal_code": "242664575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39 S FLANNAGAN AVE",
"city": "LEBANON",
"state": "VA",
"postal_code": "242664575",
"telephone_number": "276-883-5308"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ULTRA HEALTH LEBANON",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TOWN CENTER URGENT CARE LLC",
"enumeration_date": "2025-11-12",
"last_updated": "2025-11-12",
"certification_date": "2025-11-12",
"status": "A",
"authorized_official_last_name": "CLINE",
"authorized_official_first_name": "KAYLA",
"authorized_official_middle_name": "BRIANA",
"authorized_official_title_or_position": "AO",
"authorized_official_telephone_number": "276-385-1183"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, VA
- The Play Hut PLLC
- Tori Peyton Thomas
- Shelly Tincher
- Charlotte Ann Townsend
- Jared Charles Tyhurst
- Rebecca Varney
- Laura Hankins Vencill
- Holly Elizabeth Vicars
- Virginia Department of Health
- Susan Rae Wagner
All providers in Lebanon, VA · Rural Health Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.