Organization · NPI-2

Chisholm Trail Urgent Care PLLC

Emergency Medicine · Columbus, GA

NPI number1790396984
StatusActive
Last updated in NPPESAug 12, 2020

Details

NPI
1790396984
Entity type
Organization (NPI-2)
Legal business name
Chisholm Trail Urgent Care PLLC
Organization subpart
Yes
Enumeration date
Aug 12, 2020
Certification date
Aug 12, 2020
Last updated
Aug 12, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207P00000X Emergency Medicine––Yes

Practice location

11 Tsys Way
Columbus, GA 31901

Phone 877-485-4474

Mailing address

Po Box 722676
Norman, OK 73070-9033

Authorized official

Shane Parker Cole
Member
4057055977

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