Provider Demographics
NPI:1700372034
Name:LUCEDALE URGENT CARE, PC
Entity Type:Organization
Organization Name:LUCEDALE URGENT CARE, PC
Other - Org Name:LUCEDALE URGENT CARE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGOT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-445-7618
Mailing Address - Street 1:103 W FRONTAGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-5836
Mailing Address - Country:US
Mailing Address - Phone:601-947-9596
Mailing Address - Fax:251-445-3722
Practice Address - Street 1:103 W FRONTAGE RD STE C
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-5836
Practice Address - Country:US
Practice Address - Phone:251-633-0123
Practice Address - Fax:251-445-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care