Provider Demographics
NPI:1407134323
Name:BEACHCARE URGENT AND FAMILY MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:BEACHCARE URGENT AND FAMILY MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-808-3696
Mailing Address - Street 1:5059 HWY 70 W
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4503
Mailing Address - Country:US
Mailing Address - Phone:252-808-3696
Mailing Address - Fax:252-808-2022
Practice Address - Street 1:5059 HWY 70 W
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4503
Practice Address - Country:US
Practice Address - Phone:252-808-3696
Practice Address - Fax:252-808-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty