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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 : 1700112489
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 : 919-567-3139
Fax Number : 919-586-0933
Provider Business Practice Location Address
First Line : 4222 LONG BEACH RD SE
Second Line :
City : SOUTHPORT
State : NC
Zip : 28461-8627
Country : US
Telephone Number : 919-567-3139
Fax Number : 919-586-0933
Authorized Official
Title or Position : OFFICE MANAGER
Name : BRENDA BUCK
Credential :
Telephone Number : 910-577-1555
Provider Enumeration Date : 10/30/2009
Last Update Date : 10/30/2009

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