Provider Demographics
NPI:1023571411
Name:BRUNSWICK URGENT CARE, LLC
Entity Type:Organization
Organization Name:BRUNSWICK URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-574-5958
Mailing Address - Street 1:208 SCRANTON CONNECTOR STE 117
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0560
Mailing Address - Country:US
Mailing Address - Phone:912-574-5958
Mailing Address - Fax:
Practice Address - Street 1:208 SCRANTON CONNECTOR STE 117
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0560
Practice Address - Country:US
Practice Address - Phone:912-574-5958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty