Provider Demographics
NPI:1275087553
Name:PEDSPLUS URGENT CARE, LLC
Entity Type:Organization
Organization Name:PEDSPLUS URGENT CARE, LLC
Other - Org Name:CENTERCARE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICKELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURORE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:239-691-5450
Mailing Address - Street 1:1010 W KENSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8003
Mailing Address - Country:US
Mailing Address - Phone:540-289-2273
Mailing Address - Fax:540-650-3737
Practice Address - Street 1:2565 COWAN BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8440
Practice Address - Country:US
Practice Address - Phone:540-289-2273
Practice Address - Fax:540-650-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243632261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty