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General NPI Number Information
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NPI Number | 1295386662
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Entity Type | Organization
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Legal Business Name | URGENT CARE & FAMILY MEDICINE CONWAY, LLC
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 235 SINGLETON RIDGE RD STE 103
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City | CONWAY
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State | SC
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Zip | 29526-9136
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Country | US
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Telephone | 478-233-1163
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Fax |
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Provider Business Mailing Address
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Address Line | 312 KEYHOLE CT
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City | LORIS
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State | SC
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Zip | 29569-6645
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Country | US
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Telephone | 433-472-1218
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Fax | 843-347-5565
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Authorized Official
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Title or Position | OWNER
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Name | MR. DARRYL KEITH VALENTINE
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Credential | PA-C
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Telephone | 843-347-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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