MEDICARE: SOUTHERN URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1346581576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN URGENT CARE LLC

Provider Business Mailing Address
First Line	:	10 WHITAKER ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-2657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 WHITAKER ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-2657
Country	:	US
Telephone Number	:	912-898-2227
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	ARVIN WARD
Credential	:	PA-C
Telephone Number	:	912-898-2227

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	03/13/2013

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