Provider Demographics
NPI:1902839632
Name:SOUTHPORT URGENT CARE PLLS
Entity Type:Organization
Organization Name:SOUTHPORT URGENT CARE PLLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HITTER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:910-454-9989
Mailing Address - Street 1:1456 N HOWE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2754
Mailing Address - Country:US
Mailing Address - Phone:910-454-8889
Mailing Address - Fax:910-454-8890
Practice Address - Street 1:1456 N HOWE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2754
Practice Address - Country:US
Practice Address - Phone:910-454-8889
Practice Address - Fax:910-454-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902987Medicaid
NC5902987Medicaid