Provider Demographics
NPI:1831299213
Name:MID SOUTH URGENT CARE PC
Entity Type:Organization
Organization Name:MID SOUTH URGENT CARE PC
Other - Org Name:SANDHILLS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:COORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-692-5555
Mailing Address - Street 1:10935 US 15 501 HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387
Mailing Address - Country:US
Mailing Address - Phone:910-692-5555
Mailing Address - Fax:910-692-8581
Practice Address - Street 1:10935 US 15 501 HWY
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-692-5555
Practice Address - Fax:910-692-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890215NMedicaid
311696Medicare ID - Type Unspecified