Healthcare Provider Details

I. General information

NPI: 1700839826
Provider Name (Legal Business Name): NORTHSIDE URGENT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5397 RAMSEY ST
FAYETTEVILLE NC
28311
US

IV. Provider business mailing address

5397 RAMSEY ST
FAYETTEVILLE NC
28311
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-9011
  • Fax: 910-488-9057
Mailing address:
  • Phone: 910-488-9011
  • Fax: 910-488-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. INGRID Y PAYNE
Title or Position: CHIEF OPERATION OFFICER
Credential:
Phone: 910-323-1481