Provider Demographics
NPI:1750787040
Name:NEIGHBORHOOD CLINIC FAMILY & URGENT CARE PLLC
Entity type:Organization
Organization Name:NEIGHBORHOOD CLINIC FAMILY & URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:DIVYANG
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-568-5793
Mailing Address - Street 1:1095 N BRAGG BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3307
Mailing Address - Country:US
Mailing Address - Phone:910-568-5793
Mailing Address - Fax:
Practice Address - Street 1:1095 N BRAGG BLVD
Practice Address - Street 2:STE 104
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3307
Practice Address - Country:US
Practice Address - Phone:910-568-5793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501629261QU0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty