Provider Demographics
NPI:1043769524
Name:SURFSIDE BEACH URGENT CARE LLC
Entity Type:Organization
Organization Name:SURFSIDE BEACH URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-650-4006
Mailing Address - Street 1:1945 GLENNS BAY RD
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4833
Mailing Address - Country:US
Mailing Address - Phone:843-650-4006
Mailing Address - Fax:843-650-4225
Practice Address - Street 1:1945 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4833
Practice Address - Country:US
Practice Address - Phone:843-650-4006
Practice Address - Fax:843-650-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty