Provider Demographics
NPI:1801290671
Name:ANDREW T MECCA URGENT CARE LLC
Entity type:Organization
Organization Name:ANDREW T MECCA URGENT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MECCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-322-2223
Mailing Address - Street 1:5612 WHITESVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9031
Mailing Address - Country:US
Mailing Address - Phone:706-322-2223
Mailing Address - Fax:706-324-5233
Practice Address - Street 1:5612 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9031
Practice Address - Country:US
Practice Address - Phone:706-322-2223
Practice Address - Fax:706-324-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA036574261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000540196AMedicaid
GA08BBXMBOtherMEDICARE