Healthcare Provider Details

I. General information

NPI: 1174581235
Provider Name (Legal Business Name): CROSS CREEK URGENT CARE AND FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 RAMSEY ST SUITE 8
FAYETTEVILLE NC
28301-4705
US

IV. Provider business mailing address

726 RAMSEY ST SUITE 8
FAYETTEVILLE NC
28301-4705
US

V. Phone/Fax

Practice location:
  • Phone: 910-221-2200
  • Fax: 910-221-2201
Mailing address:
  • Phone: 910-221-2200
  • Fax: 910-221-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MR. GLENN MARTIN STANLEY SR.
Title or Position: PRESIDENT
Credential: PA C
Phone: 910-221-2200