Provider Demographics
NPI:1164819835
Name:CONVENIENT CARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:CONVENIENT CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-574-1969
Mailing Address - Street 1:923 HADDONFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2752
Mailing Address - Country:US
Mailing Address - Phone:856-324-8246
Mailing Address - Fax:
Practice Address - Street 1:923 HADDONFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2752
Practice Address - Country:US
Practice Address - Phone:856-324-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445342207P00000X
PAOS015197207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty