Provider Demographics
NPI:1427389865
Name:MASONBORO URGENT CARE, PC
Entity Type:Organization
Organization Name:MASONBORO URGENT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-794-4947
Mailing Address - Street 1:6132 CAROLINA BEACH RD
Mailing Address - Street 2:UNIT 8
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2788
Mailing Address - Country:US
Mailing Address - Phone:910-794-4947
Mailing Address - Fax:910-794-4943
Practice Address - Street 1:6132 CAROLINA BEACH RD
Practice Address - Street 2:UNIT 8
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2788
Practice Address - Country:US
Practice Address - Phone:910-794-4947
Practice Address - Fax:910-794-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913688Medicaid
NC2075749Medicare PIN