1336486646 NPI number — URGENT CARES OF AMERICA NORTH CAROLINA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336486646 NPI number — URGENT CARES OF AMERICA NORTH CAROLINA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARES OF AMERICA NORTH CAROLINA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FASTMED URGENT CARE OF APEX
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336486646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9276 SCRANTON RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121-7701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 CREEKSIDE LANDING DR
Provider Second Line Business Practice Location Address:
C-110
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-3982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-249-1529
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HEINE
Authorized Official First Name:
KENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
858-964-1506

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  0010-04751 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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