Provider Demographics
NPI:1164805545
Name:MEDCARE EXPRESS NORTH CHARLESTON
Entity Type:Organization
Organization Name:MEDCARE EXPRESS NORTH CHARLESTON
Other - Org Name:MEDCARE URGENT CARE GREENVILLE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-576-5246
Mailing Address - Street 1:6120 WHITE HORSE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-3852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4936
Practice Address - Country:US
Practice Address - Phone:843-576-5246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5210Medicaid
SC8736Medicare UPIN