Provider Demographics
NPI: | 1245805795 |
---|---|
Name: | MEDCARE EXPRESS - NORTH CHARLESTON LLC |
Entity Type: | Organization |
Organization Name: | MEDCARE EXPRESS - NORTH CHARLESTON LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | PRIDEAUX |
Authorized Official - Last Name: | LAKEMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-656-2730 |
Mailing Address - Street 1: | 216 CENTERVIEW DR STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | BRENTWOOD |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37027-3226 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-656-2750 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3816 HIGHWAY 17 S |
Practice Address - Street 2: | |
Practice Address - City: | NORTH MYRTLE BEACH |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29582-5069 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-272-1411 |
Practice Address - Fax: | 843-272-2130 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MEDCARE EXPRESS - NORTH CHARLESTON LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2021-05-26 |
Last Update Date: | 2021-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |