Provider Demographics
NPI:1952397028
Name:IMMEDIATE CARE OF GOLDSBORO, PLLC
Entity Type:Organization
Organization Name:IMMEDIATE CARE OF GOLDSBORO, PLLC
Other - Org Name:CORRECT LEGAL BUSINESS NAME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-580-0004
Mailing Address - Street 1:2604 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534
Mailing Address - Country:US
Mailing Address - Phone:919-580-0004
Mailing Address - Fax:919-580-9099
Practice Address - Street 1:2604 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-580-0004
Practice Address - Fax:919-580-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890250UMedicaid
0250UOtherBLUE CROSS BLUE SHIELD
NC890250UMedicaid