MEDICARE: GRAHAM MOBILE URGENT CARE 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1871186825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAHAM MOBILE URGENT CARE PC

Provider Business Mailing Address
First Line	:	217 E ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3021
Country	:	US
Telephone Number	:	336-350-8039
Fax Number	:	336-350-8393

Provider Business Practice Location Address
First Line	:	217 E ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3021
Country	:	US
Telephone Number	:	336-350-8039
Fax Number	:	336-350-8393

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEONARD FLORES POLANCO
Credential	:	MD
Telephone Number	:	336-350-8039

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	02/19/2021

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