Healthcare Provider Details

I. General information

NPI: 1275082141
Provider Name (Legal Business Name): U.S. HEALTHWORKS MEDICAL GROUP OF NORTH CAROLINA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7360 W FRIENDLY AVE SUITE 102
GREENSBORO NC
27410-6247
US

IV. Provider business mailing address

25124 SPRINGFIELD CT 200
VALENCIA CA
91355-1085
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-3184
  • Fax: 910-323-9577
Mailing address:
  • Phone: 661-678-2600
  • Fax: 661-678-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOSEPH T MALLAS
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 661-678-2600