Provider Demographics
NPI:1598116642
Name:NORTHSIDE PRIMARY & URGENT CARE
Entity Type:Organization
Organization Name:NORTHSIDE PRIMARY & URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SELVARATNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SINNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-308-0196
Mailing Address - Street 1:PO BOX 87064
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7064
Mailing Address - Country:US
Mailing Address - Phone:910-488-9011
Mailing Address - Fax:910-488-9057
Practice Address - Street 1:5397 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1417
Practice Address - Country:US
Practice Address - Phone:910-488-9011
Practice Address - Fax:910-488-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00034310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty