Basic Information
| Provider Information | |||||||||
| NPI: | 1841252046 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEACHCARE URGENT MEDICAL CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1409 | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285571409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528083696 | ||||||||
| FaxNumber: | 2528083022 | ||||||||
| Practice Location | |||||||||
| Address1: | 5059 HWY 70 W | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285574503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528083696 | ||||||||
| FaxNumber: | 2528082022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 08/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | JEFFERY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2528083696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 39759 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 890198B | 05 | NC | MEDICAID |