Provider Demographics
NPI:1073061495
Name:MEDACCESS URGENT CARE, PLLC
Entity Type:Organization
Organization Name:MEDACCESS URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:STALNAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-330-0400
Mailing Address - Street 1:PO BOX 1811
Mailing Address - Street 2:STE C4
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-1811
Mailing Address - Country:US
Mailing Address - Phone:336-330-0400
Mailing Address - Fax:336-330-0031
Practice Address - Street 1:1840 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE C4
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7415
Practice Address - Country:US
Practice Address - Phone:919-510-6679
Practice Address - Fax:919-967-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146315261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335857Medicare UPIN