Provider Demographics
NPI:1144678715
Name:CAROLINA CONVENIENT CARE, PLLC
Entity type:Organization
Organization Name:CAROLINA CONVENIENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-272-4158
Mailing Address - Street 1:106 RIDGE VIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6647
Mailing Address - Country:US
Mailing Address - Phone:919-319-6363
Mailing Address - Fax:919-319-1331
Practice Address - Street 1:106 RIDGE VIEW DR STE A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6647
Practice Address - Country:US
Practice Address - Phone:919-319-6363
Practice Address - Fax:919-319-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC216411261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care