1659380079 NPI number — UNION URGENT CARE LLC

Table of content: (NPI 1659380079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659380079 NPI number — UNION URGENT CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION URGENT CARE LLC
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:
CAROLINAS HEALTHCARE URGENT CARE - UNION WEST
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:
1659380079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60735
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-0735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-246-2777
Provider Business Mailing Address Fax Number:
704-246-4788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6030 W HIGHWAY 74
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
INDIAN TRAIL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28079-3468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-246-2777
Provider Business Practice Location Address Fax Number:
704-246-4788
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIENS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
704-355-0648

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 017G2 . This is a "BLUE CROSS - BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5901877 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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