Provider Demographics
NPI:1679005110
Name:SUSSEX COMMUNITY URGENT CARE A PC
Entity Type:Organization
Organization Name:SUSSEX COMMUNITY URGENT CARE A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4307
Mailing Address - Street 1:20 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-2537
Mailing Address - Country:US
Mailing Address - Phone:973-983-5570
Mailing Address - Fax:973-983-1616
Practice Address - Street 1:20 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07461-2537
Practice Address - Country:US
Practice Address - Phone:973-983-5570
Practice Address - Fax:973-983-1616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES - SAINT CLARES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty