1669705117 NPI number — HENDERSONVILLE URGENT CARE PC

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 1669705117 NPI number — HENDERSONVILLE URGENT CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDERSONVILLE URGENT CARE PC
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:
Provider Other Organization Name Type Code:
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:
1669705117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 SHOTWELL RD
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-550-0821
Provider Business Mailing Address Fax Number:
919-550-0735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 SPARTANBURG HWY
Provider Second Line Business Practice Location Address:
STE 17
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-233-1664
Provider Business Practice Location Address Fax Number:
828-233-1668
Provider Enumeration Date:
09/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
NENA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official Telephone Number:
919-550-0821

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , 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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