Provider Demographics
NPI:1003156670
Name:NEIGHBORHOOD URGENT CARE PLLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-557-6667
Mailing Address - Street 1:9764 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-7620
Mailing Address - Country:US
Mailing Address - Phone:919-557-6667
Mailing Address - Fax:919-557-0344
Practice Address - Street 1:9764 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539
Practice Address - Country:US
Practice Address - Phone:919-557-6667
Practice Address - Fax:919-557-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG01035Medicare UPIN