Basic Information
| Provider Information | |||||||||
| NPI: | 1952626855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILLCREST URGENT CARE, FAMILY PRACTICE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1309 LEES CHAPEL RD | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362865505 | ||||||||
| FaxNumber: | 3362882900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 LEES CHAPEL RD | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362865505 | ||||||||
| FaxNumber: | 3362882900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2010 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | ZAMMI | ||||||||
| AuthorizedOfficialFirstName: | CHRISTA | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3362865505 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 025J3 | 01 | NC | BCBS OF NC | OTHER | 5919533 | 05 | NC | MEDICAID |