Provider Demographics
NPI:1023734803
Name:DOCTORS OWN URGENT CARE
Entity type:Organization
Organization Name:DOCTORS OWN URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:DIETSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:262-364-8060
Mailing Address - Street 1:5692 MOSSBANK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-9839
Mailing Address - Country:US
Mailing Address - Phone:262-364-8060
Mailing Address - Fax:
Practice Address - Street 1:4807 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4503
Practice Address - Country:US
Practice Address - Phone:262-364-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care