Healthcare Provider Details

I. General information

NPI: 1356463491
Provider Name (Legal Business Name): JOHNSTON MEMORIAL QUIKMED III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N BRIGHTLEAF BLVD SUITE 1200
SMITHFIELD NC
27577-4407
US

IV. Provider business mailing address

514 N BRIGHTLEAF BLVD SUITE 1200
SMITHFIELD NC
27577-4407
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-0257
  • Fax: 919-938-0296
Mailing address:
  • Phone: 919-938-0257
  • Fax: 919-938-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYLE MCDERMOTT
Title or Position: VP MANAGEMENT SERVICES
Credential:
Phone: 919-938-7115