Provider Demographics
NPI:1528643608
Name:GOLD STAR URGENT CARE LLC
Entity type:Organization
Organization Name:GOLD STAR URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:SIERRA
Authorized Official - Last Name:LANE-MILO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:843-506-9836
Mailing Address - Street 1:960 PAMPLICO HWY STE L
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6244
Mailing Address - Country:US
Mailing Address - Phone:843-804-6689
Mailing Address - Fax:
Practice Address - Street 1:514 2ND LOOP RD STE E
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2848
Practice Address - Country:US
Practice Address - Phone:843-407-4451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care