Provider Demographics
NPI:1932631371
Name:CONVENIENT CARE, LLC
Entity Type:Organization
Organization Name:CONVENIENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-217-0088
Mailing Address - Street 1:207 31ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6703
Mailing Address - Country:US
Mailing Address - Phone:229-217-0088
Mailing Address - Fax:229-217-0086
Practice Address - Street 1:207 31ST AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6703
Practice Address - Country:US
Practice Address - Phone:229-217-0088
Practice Address - Fax:229-217-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I088550Medicare UPIN
GA202I507615Medicare UPIN
GA202G706991Medicare PIN