Provider Demographics
NPI:1417131459
Name:URGENT CARE CENTERS OF CAROLINA, INC.
Entity Type:Organization
Organization Name:URGENT CARE CENTERS OF CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-791-6015
Mailing Address - Street 1:PO BOX 281774
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1774
Mailing Address - Country:US
Mailing Address - Phone:910-395-9984
Mailing Address - Fax:
Practice Address - Street 1:3722 BRIDGES ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2944
Practice Address - Country:US
Practice Address - Phone:252-726-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDA3125OtherMEDICARE RR
NC5236930001Medicare NSC