1548414501 NPI number — URGENT CARE OF THE UPSTATE, INC.

Table of content: (NPI 1548414501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548414501 NPI number — URGENT CARE OF THE UPSTATE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE OF THE UPSTATE, 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:
INTEGRATIVE PAIN MANAGEMENT
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:
1548414501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 VILLAGE CIR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-726-9605
Provider Business Mailing Address Fax Number:
985-726-9633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556 MEMORIAL DRIVE EXT STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29651-1154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-848-2300
Provider Business Practice Location Address Fax Number:
864-848-2323
Provider Enumeration Date:
11/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GALLOWAY
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
985-726-9605

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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