Organization Name: | COMMUNITY CARE SPECIALISTS & URGENT CARE LLC |
NPI Number: | 1649583519 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANITA L JACKSON (CEO) |
Mailing Address: | 3721 Lynn Rd Suite 104 Raleigh |
State: | NC US |
Postal Code: | 276133854 |
Phone Number: | 9197588610 |
Fax Number: | 9197588613 |
NPI Enumeration Date: | 07/21/2010 |
NPI Last Update Date: | 07/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |