MEDICARE: URGENT CARE CENTERS OF CAROLINA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA3125	OTHER	NC	MEDICARE RR

General Provider Information

NPI Number	:	1417131459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT CARE CENTERS OF CAROLINA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 281774
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-1774
Country	:	US
Telephone Number	:	910-395-9984
Fax Number	:

Provider Business Practice Location Address
First Line	:	3722 BRIDGES ST
Second Line	:	SUITE A
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2944
Country	:	US
Telephone Number	:	252-726-1116
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETE GRATALE
Credential	:
Telephone Number	:	910-791-6015

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	11/11/2008

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