Provider Demographics
NPI:1750448791
Name:STATCARE, LLC
Entity Type:Organization
Organization Name:STATCARE, LLC
Other - Org Name:STATCARE URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-826-7828
Mailing Address - Street 1:P.O. BOX 87707
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-826-7828
Mailing Address - Fax:910-864-7925
Practice Address - Street 1:9525 CLIFFDALE RD.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-826-7925
Practice Address - Fax:910-864-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC027AUOtherBCBS
NC5903128Medicaid
NC027AUOtherBCBS