Organization
GOLDEN TRIANGLE URGENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUDY BLANK (CFO)
(615) 988-2005
Entity
Organization
Contact information
Practice address
500 RUSSELL ST STE 3, STARKVILLE, MS 39759-5411
(662) 324-2244
(662) 324-2295
Mailing address
30 BURTON HILLS BLVD, SUITE 175, NASHVILLE, TN 37215-6403
(615) 988-2009
(615) 250-9773
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04351854
—
MS
Enumeration date
10/05/2012
Last updated
12/02/2022
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