MEDICARE: PIEDMONT URGENT CARE CENTER AT BAXTER VILLAGE LLC

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972590073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT URGENT CARE CENTER AT BAXTER VILLAGE LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 741327
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-1327
Country	:	US
Telephone Number	:	803-396-8100
Fax Number	:	803-396-8040

Provider Business Practice Location Address
First Line	:	502 SIXTH BAXTER CROSSING
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6428
Country	:	US
Telephone Number	:	803-396-8100
Fax Number	:	803-396-8040

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JOHN HOLLAND
Credential	:
Telephone Number	:	469-893-2030

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	09/17/2010

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