Basic Information
| Provider Information | |||||||||
| NPI: | 1669708343 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOSS URGENT CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 579 | ||||||||
| Address2: | |||||||||
| City: | FUQUAY VARINA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275260579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195673139 | ||||||||
| FaxNumber: | 9195860933 | ||||||||
| Practice Location | |||||||||
| Address1: | 7212 GB ALFORD HWY | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275407661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195673139 | ||||||||
| FaxNumber: | 9195860933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2009 | ||||||||
| LastUpdateDate: | 10/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | BUCK | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9105771555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 1497080220 | 01 | NC | GROUP NPI | OTHER |