Provider Demographics
NPI:1144643909
Name:SOUTH JERSEY URGICARE LLC
Entity type:Organization
Organization Name:SOUTH JERSEY URGICARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-213-5900
Mailing Address - Street 1:3722 E LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7926
Mailing Address - Country:US
Mailing Address - Phone:856-213-5900
Mailing Address - Fax:856-213-5905
Practice Address - Street 1:3722 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7926
Practice Address - Country:US
Practice Address - Phone:856-213-5900
Practice Address - Fax:856-213-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care