Provider Demographics
NPI:1407172752
Name:MT. PLEASANT URGENT CARE AND FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:MT. PLEASANT URGENT CARE AND FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARI LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-410-4580
Mailing Address - Street 1:1464 MOUNT PLEASANT RD
Mailing Address - Street 2:UNIT 16 #502
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4043
Mailing Address - Country:US
Mailing Address - Phone:757-410-4580
Mailing Address - Fax:
Practice Address - Street 1:1464 MOUNT PLEASANT RD
Practice Address - Street 2:UNIT 13 & 14
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4043
Practice Address - Country:US
Practice Address - Phone:757-410-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty