Provider Demographics
NPI:1295284784
Name:CAROLINA FOREST URGENT CARE LLC
Entity type:Organization
Organization Name:CAROLINA FOREST URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:VANDERGRIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-945-3030
Mailing Address - Street 1:PO BOX 2128
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2128
Mailing Address - Country:US
Mailing Address - Phone:854-223-4831
Mailing Address - Fax:854-212-7381
Practice Address - Street 1:185 FRESH DR
Practice Address - Street 2:SUITE A
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4436
Practice Address - Country:US
Practice Address - Phone:843-945-3030
Practice Address - Fax:843-492-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty