Provider Demographics
NPI:1912119744
Name:CHEROKEE URGENT CARE CENTER
Entity Type:Organization
Organization Name:CHEROKEE URGENT CARE CENTER
Other - Org Name:EASTERN BAND OF CHEROKEE INDIANS OF NORTH CAROLINA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM MANAGER URGENT CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERRI
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:BS BA
Authorized Official - Phone:828-497-9036
Mailing Address - Street 1:PO BOX 2039
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-2039
Mailing Address - Country:US
Mailing Address - Phone:828-497-9036
Mailing Address - Fax:828-497-5656
Practice Address - Street 1:75 PAINTOWN ROAD
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719
Practice Address - Country:US
Practice Address - Phone:828-497-9036
Practice Address - Fax:828-497-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-13
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-21
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
NC9901380261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012JNMedicaid
NC89012JNMedicaid