Provider Demographics
NPI:1801453089
Name:MEDIQ URGENT CARE PC
Entity type:Organization
Organization Name:MEDIQ URGENT CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEEZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QAYUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-738-1691
Mailing Address - Street 1:12201 N NC HIGHWAY 150 STE 11
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9731
Mailing Address - Country:US
Mailing Address - Phone:336-842-1142
Mailing Address - Fax:336-842-1182
Practice Address - Street 1:12201 N NC HIGHWAY 150 STE 11
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9731
Practice Address - Country:US
Practice Address - Phone:336-842-1142
Practice Address - Fax:336-842-1182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIQ URGENT CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-23
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care