Provider Demographics
NPI:1295386662
Name:URGENT CARE & FAMILY MEDICINE CONWAY, LLC
Entity Type:Organization
Organization Name:URGENT CARE & FAMILY MEDICINE CONWAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:843-347-2121
Mailing Address - Street 1:312 KEYHOLE CT
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-6645
Mailing Address - Country:US
Mailing Address - Phone:433-472-1218
Mailing Address - Fax:843-347-5565
Practice Address - Street 1:235 SINGLETON RIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9136
Practice Address - Country:US
Practice Address - Phone:478-233-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty