Provider Demographics
NPI:1922248251
Name:URGENT CARE OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:URGENT CARE OBSTETRICS & GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:V
Authorized Official - Last Name:PONDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-480-4880
Mailing Address - Street 1:413 OWEN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3489
Mailing Address - Country:US
Mailing Address - Phone:910-480-4880
Mailing Address - Fax:910-488-4856
Practice Address - Street 1:413 OWEN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3489
Practice Address - Country:US
Practice Address - Phone:910-480-4880
Practice Address - Fax:910-488-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900735261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care