Provider Demographics
NPI:1619246717
Name:OCCUMED WALK IN & URGENT CARE, PLLC
Entity Type:Organization
Organization Name:OCCUMED WALK IN & URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:ROSENBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-574-0707
Mailing Address - Street 1:530 N. ELAM AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403
Mailing Address - Country:US
Mailing Address - Phone:336-574-0707
Mailing Address - Fax:336-574-0039
Practice Address - Street 1:530 N. ELAM AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403
Practice Address - Country:US
Practice Address - Phone:336-574-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891193AMedicaid