1336235225 NPI number — FUQUAY URGENT CARE & FAMILY CLINIC INC.

Table of content: (NPI 1336235225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336235225 NPI number — FUQUAY URGENT CARE & FAMILY CLINIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FUQUAY URGENT CARE & FAMILY CLINIC 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:
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:
1336235225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2011
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:
SUITE 108
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27520-5597
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:
1418 N. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FUQUAY-VARINA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27526-8901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-552-1733
Provider Business Practice Location Address Fax Number:
919-552-1495
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CATTO
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VP OF PRACTICE SERVICES
Authorized Official Telephone Number:
919-550-0821

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015A6 . This is a "BCBS OF NC GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7675656 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89015A6 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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