Basic Information
| Provider Information | |||||||||
| NPI: | 1093219271 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | URGENT CARE OF BERWICK LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | URGENT CARE OF SANDFLY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 OGEECHEE RD STE 192 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314059521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122011140 | ||||||||
| FaxNumber: | 9127776449 | ||||||||
| Practice Location | |||||||||
| Address1: | 7360 SKIDAWAY RD STE L2 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122011140 | ||||||||
| FaxNumber: | 9127776449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | STANLEY | ||||||||
| AuthorizedOfficialFirstName: | CORY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PA | ||||||||
| AuthorizedOfficialTelephone: | 9122011140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | URGENT CARE OF BERWICK LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.