Basic Information
| Provider Information | |||||||||
| NPI: | 1083018485 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | URGENT CARE OF BERWICK LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | URGENT CARE OF BERWICK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 BROWN THRUSH RD | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314190016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122011140 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5730 OGEECHEE RD STE 192 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314059521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122011140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2014 | ||||||||
| LastUpdateDate: | 12/20/2014 | ||||||||
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| AuthorizedOfficialLastName: | STANLEY | ||||||||
| AuthorizedOfficialFirstName: | CORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER, CEO | ||||||||
| AuthorizedOfficialTelephone: | 8282751860 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 061648 | GA | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.