Provider Demographics
NPI:1497030498
Name:PEDIATRICS URGENT CARE PLLC
Entity Type:Organization
Organization Name:PEDIATRICS URGENT CARE PLLC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:304-596-2345
Mailing Address - Street 1:128 HEALTH CARE LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4009
Mailing Address - Country:US
Mailing Address - Phone:304-596-2345
Mailing Address - Fax:304-264-9128
Practice Address - Street 1:128 HEALTH CARE LN
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4009
Practice Address - Country:US
Practice Address - Phone:304-596-2345
Practice Address - Fax:304-264-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2257-14722080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Single Specialty