Provider Demographics
NPI:1871186825
Name:GRAHAM MOBILE URGENT CARE PC
Entity Type:Organization
Organization Name:GRAHAM MOBILE URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-350-8039
Mailing Address - Street 1:217 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3021
Mailing Address - Country:US
Mailing Address - Phone:336-350-8039
Mailing Address - Fax:336-350-8393
Practice Address - Street 1:217 E ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3021
Practice Address - Country:US
Practice Address - Phone:336-350-8039
Practice Address - Fax:336-350-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care