Provider Demographics
NPI:1457397192
Name:GRAHAM URGENT CARE PA
Entity type:Organization
Organization Name:GRAHAM URGENT CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JUSTAIN
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:336-228-9671
Mailing Address - Street 1:217 EAST ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253
Mailing Address - Country:US
Mailing Address - Phone:336-228-9671
Mailing Address - Fax:336-228-9674
Practice Address - Street 1:217 EAST ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:336-228-9671
Practice Address - Fax:336-228-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39064261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017RHOtherBLUE CROSS BLUE SHIELD OF
NC5902891Medicaid
NC2330460Medicare PIN