Healthcare Provider Details

I. General information

NPI: 1548414501
Provider Name (Legal Business Name): URGENT CARE OF THE UPSTATE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 MEMORIAL DRIVE EXT STE A
GREER SC
29651-1154
US

IV. Provider business mailing address

202 VILLAGE CIR STE 1
SLIDELL LA
70458
US

V. Phone/Fax

Practice location:
  • Phone: 864-848-2300
  • Fax: 864-848-2323
Mailing address:
  • Phone: 985-726-9605
  • Fax: 985-726-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE A GALLOWAY
Title or Position: PRESIDENT
Credential:
Phone: 985-726-9605