MEDICARE: BEACHCARE EAST URGENT MEDICAL CENTER PC

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	261QP2300X	Primary Care Clinic/Center	39759	NC

General Provider Information

NPI Number	:	1679745434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACHCARE EAST URGENT MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	106 PROFESSIONAL PARK DR STE D
Second Line	:
City	:	BEAUFORT
State	:	NC
Zip	:	28516-2464
Country	:	US
Telephone Number	:	252-728-2205
Fax Number	:	252-728-3248

Provider Business Practice Location Address
First Line	:	5059 HWY 70 W
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4503
Country	:	US
Telephone Number	:	252-808-3696
Fax Number	:	252-808-2022

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFERY S ANDERSON
Credential	:	MD
Telephone Number	:	252-808-3696

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	05/21/2008

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