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NPI Code Detail

MEDICARE: BOSS URGENT CARE, PLLC

MEDICARE: BOSS URGENT CARE, PLLC
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
1261QU0200XUrgent Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11497080220OTHERNCGROUP NPI

General Provider Information

NPI Number : 1689901621
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOSS URGENT CARE, PLLC
Provider Business Mailing Address
First Line : PO BOX 579
Second Line :
City : FUQUAY VARINA
State : NC
Zip : 27526-0579
Country : US
Telephone Number : 910-577-1555
Fax Number : 910-577-1591
Provider Business Practice Location Address
First Line : 325 WESTERN BLVD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-6341
Country : US
Telephone Number : 910-577-1555
Fax Number : 910-577-1591
Authorized Official
Title or Position : OFFICE MANAGER
Name : BRENDA L BUCK
Credential :
Telephone Number : 910-577-1555
Provider Enumeration Date : 11/12/2009
Last Update Date : 11/12/2009

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Directions to “BOSS URGENT CARE, PLLC ” Practice Location

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