MEDICARE: URGENT CARES OF AMERICA NORTH 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	332900000X	Non-Pharmacy Dispensing Site	0010-00647	NC

General Provider Information

NPI Number	:	1659741361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT CARES OF AMERICA NORTH CAROLINA INC

Provider Business Mailing Address
First Line	:	9276 SCRANTON RD
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-7701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1262 EAST BROAD AVENUE
Second Line	:
City	:	ROCKINGHAM
State	:	NC
Zip	:	28379
Country	:	US
Telephone Number	:	910-817-9200
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	KENNY HEINE
Credential	:
Telephone Number	:	858-964-1506

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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