Healthcare Provider Details

I. General information

NPI: 1053191320
Provider Name (Legal Business Name): GOLD STAR URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 2ND LOOP RD STE E
FLORENCE SC
29505-2848
US

IV. Provider business mailing address

960 PAMPLICO HWY STE L
FLORENCE SC
29505-6244
US

V. Phone/Fax

Practice location:
  • Phone: 843-407-4451
  • Fax:
Mailing address:
  • Phone: 843-407-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATOYA SIERRA LANE-MILO
Title or Position: OWNER
Credential:
Phone: 843-407-4451