Provider Demographics
NPI:1154354942
Name:DELCO URGENT CARE LLC
Entity type:Organization
Organization Name:DELCO URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:910-655-9900
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:25805 ANDREW JACKSON HIGHWAY
Mailing Address - City:DELCO
Mailing Address - State:NC
Mailing Address - Zip Code:28436-0619
Mailing Address - Country:US
Mailing Address - Phone:910-655-9900
Mailing Address - Fax:910-655-9907
Practice Address - Street 1:25805 ANDREW JACKSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436
Practice Address - Country:US
Practice Address - Phone:910-655-9900
Practice Address - Fax:910-655-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2337106Medicare ID - Type Unspecified