MEDICARE: BOSS URGENT CARE PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1497080220	OTHER	NC	GROUP NPI

General Provider Information

NPI Number	:	1669708343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSS URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 579
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-0579
Country	:	US
Telephone Number	:	919-567-3139
Fax Number	:	919-586-0933

Provider Business Practice Location Address
First Line	:	7212 GB ALFORD HWY
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7661
Country	:	US
Telephone Number	:	919-567-3139
Fax Number	:	919-586-0933

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRENDA BUCK
Credential	:
Telephone Number	:	910-577-1555

Provider Enumeration Date	:	10/30/2009
Last Update Date	:	10/30/2009

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