Healthcare Provider Details

I. General information

NPI: 1023271210
Provider Name (Legal Business Name): SOUTHCARE MINUTE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 MARKET ST
WILMINGTON NC
28401-4871
US

IV. Provider business mailing address

PO BOX 2137
WILMINGTON NC
28402-2137
US

V. Phone/Fax

Practice location:
  • Phone: 910-254-4065
  • Fax: 910-763-8258
Mailing address:
  • Phone: 910-254-4065
  • Fax: 910-763-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY A CAINES
Title or Position: PRESIDENT
Credential:
Phone: 910-520-3099