Provider Demographics
NPI:1942301544
Name:MDCAROLINA, PA
Entity Type:Organization
Organization Name:MDCAROLINA, PA
Other - Org Name:PIEDMONT WEST URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-628-0004
Mailing Address - Street 1:1190 FILBERT HWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-9324
Mailing Address - Country:US
Mailing Address - Phone:803-628-0004
Mailing Address - Fax:803-628-6004
Practice Address - Street 1:1190 FILBERT HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-9324
Practice Address - Country:US
Practice Address - Phone:803-628-0004
Practice Address - Fax:803-628-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX ID
SC=========OtherTAX ID