Provider Demographics
NPI:1750490876
Name:GUARDIAN HART MEDICAL CARE
Entity Type:Organization
Organization Name:GUARDIAN HART MEDICAL CARE
Other - Org Name:CEDAR CREEK URGENT CARE AND FAMILY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-221-1590
Mailing Address - Street 1:1074 SOUTHERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-221-1590
Mailing Address - Fax:910-221-1594
Practice Address - Street 1:1074 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306
Practice Address - Country:US
Practice Address - Phone:910-221-1590
Practice Address - Fax:910-221-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128677261QP2300X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC59-01572Medicaid
NC014A1OtherBCBS
NC014A1OtherBLUE CROSS BLUE SHIELD
NC59-01572Medicaid
NCDC7442Medicare UPIN
NC014A1OtherBLUE CROSS BLUE SHIELD