Basic Information
| Provider Information | |||||||||
| NPI: | 1932432481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOONE UC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11373 US HIGHWAY 70 WEST | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195500821 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 HIGHWAY 105 EXT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195500821 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2009 | ||||||||
| LastUpdateDate: | 09/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9195500821 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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.