Provider Demographics
NPI:1821100868
Name:SHALLOTTE URGENT CARE PA
Entity Type:Organization
Organization Name:SHALLOTTE URGENT CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-755-5440
Mailing Address - Street 1:110 SHALLOTTE CROSSING PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-8116
Mailing Address - Country:US
Mailing Address - Phone:910-755-5440
Mailing Address - Fax:910-755-5420
Practice Address - Street 1:110 SHALLOTTE CROSSING PKWY STE 2
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-8116
Practice Address - Country:US
Practice Address - Phone:910-755-5440
Practice Address - Fax:910-755-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care