Healthcare Provider Details

I. General information

NPI: 1386112993
Provider Name (Legal Business Name): AIKEN URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SASANQUA DRIVE
GRANITEVILLE SC
29829-5555
US

IV. Provider business mailing address

PO BOX 3046
MALVERN PA
19355-0746
US

V. Phone/Fax

Practice location:
  • Phone: 610-382-4943
  • Fax:
Mailing address:
  • Phone: 803-392-1811
  • Fax: 803-761-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SMITH
Title or Position: CFO
Credential:
Phone: 610-768-3300