Provider Demographics
NPI:1679966022
Name:CARECENTRAL URGENT CARE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:CARECENTRAL URGENT CARE MEDICAL GROUP PC
Other - Org Name:CARECENTRAL URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-986-0110
Mailing Address - Street 1:682 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2704
Mailing Address - Country:US
Mailing Address - Phone:781-341-2800
Mailing Address - Fax:781-341-2828
Practice Address - Street 1:286 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1763
Practice Address - Country:US
Practice Address - Phone:781-341-2800
Practice Address - Fax:781-341-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care