Provider Demographics
NPI:1740893734
Name:BLUE TELEPSYCH URGENT CARE
Entity type:Organization
Organization Name:BLUE TELEPSYCH URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAZAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-523-1825
Mailing Address - Street 1:8406 FIDDLESTICK WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3394
Mailing Address - Country:US
Mailing Address - Phone:910-523-1825
Mailing Address - Fax:
Practice Address - Street 1:8406 FIDDLESTICK WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-3394
Practice Address - Country:US
Practice Address - Phone:910-523-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty