Provider Demographics
NPI:1225312945
Name:LAKE JEANETTE URGENT CARE
Entity Type:Organization
Organization Name:LAKE JEANETTE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:NEVITTA
Authorized Official - Last Name:COMMA-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:336-286-5505
Mailing Address - Street 1:1309 LEES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2601
Mailing Address - Country:US
Mailing Address - Phone:336-286-5505
Mailing Address - Fax:336-286-5593
Practice Address - Street 1:1309 LEES CHAPEL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2601
Practice Address - Country:US
Practice Address - Phone:336-286-5505
Practice Address - Fax:336-286-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care