Provider Demographics
NPI:1316119282
Name:MEDACCESS URGENT CARE, PLLC
Entity type:Organization
Organization Name:MEDACCESS URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/BILLING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:STALNAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-330-0400
Mailing Address - Street 1:PO BOX 1811
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-1811
Mailing Address - Country:US
Mailing Address - Phone:336-330-0400
Mailing Address - Fax:336-330-0031
Practice Address - Street 1:3762 DURHAM RD
Practice Address - Street 2:STE A
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-2741
Practice Address - Country:US
Practice Address - Phone:336-330-0400
Practice Address - Fax:336-330-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146315261QP2300X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1154559581Medicare NSC
6202610001Medicare NSC