1417131459 NPI number — URGENT CARE CENTERS OF CAROLINA, INC.

Table of content: (NPI 1417131459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417131459 NPI number — URGENT CARE CENTERS OF CAROLINA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE CENTERS OF 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:
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:
1417131459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 281774
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-1774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-395-9984
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3722 BRIDGES ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-726-1116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRATALE
Authorized Official First Name:
PETE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-791-6015

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA3125 . This is a "MEDICARE RR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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