Healthcare Provider Details

I. General information

NPI: 1881987691
Provider Name (Legal Business Name): TRI-CITY FAMILY MEDICINE & URGENT CARE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 HYANNIS DR
HOLLY SPRINGS NC
27540-8336
US

IV. Provider business mailing address

107 HYANNIS DR
HOLLY SPRINGS NC
27540-8336
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-8666
  • Fax: 919-363-8668
Mailing address:
  • Phone: 919-363-8666
  • Fax: 919-363-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AVANI PATEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-363-8666