Provider Demographics
NPI:1881353423
Name:NITEOWL PEDIATRIC URGENT CARE LLC
Entity type:Organization
Organization Name:NITEOWL PEDIATRIC URGENT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEOPARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:803-961-5001
Mailing Address - Street 1:616 EDGEFIELD RD STE 180
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-6407
Mailing Address - Country:US
Mailing Address - Phone:803-961-5001
Mailing Address - Fax:803-961-2017
Practice Address - Street 1:616 EDGEFIELD RD STE 180
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6407
Practice Address - Country:US
Practice Address - Phone:803-640-7953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty