| Organization Name: | COMMUNITY QUICK CARE OF LAVERGNE, PC |
| NPI Number: | 1194023366 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY P. ELEDGE (CEO) |
| Mailing Address: | 5148a Murfreesboro Rd La Vergne |
| State: | TN US |
| Postal Code: | 370862712 |
| Phone Number: | 6152131203 |
| Fax Number: | 6155270270 |
| NPI Enumeration Date: | 03/11/2011 |
| NPI Last Update Date: | 06/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 339630 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |