Provider Demographics
NPI:1598157182
Name:ATLANTICARE URGENT CARE PHYSICIANS LLC
Entity Type:Organization
Organization Name:ATLANTICARE URGENT CARE PHYSICIANS LLC
Other - Org Name:ATLANTICARE URGENT CARE MOUNT LAUREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSIONAL REV CYCLE BUS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-272-6860
Mailing Address - Street 1:5626 OBERLIN DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3131 ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9757
Practice Address - Country:US
Practice Address - Phone:609-569-7040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDVANTX,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-19
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06977500332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site