Provider Demographics
NPI:1871064949
Name:PARK URGENT CARE PLLC
Entity type:Organization
Organization Name:PARK URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:N
Authorized Official - Last Name:POLAVARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-261-6677
Mailing Address - Street 1:2025 GIOVANNI CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7106
Mailing Address - Country:US
Mailing Address - Phone:919-261-6677
Mailing Address - Fax:919-261-6860
Practice Address - Street 1:7560 CARPENTER FIRE STATION RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8616
Practice Address - Country:US
Practice Address - Phone:919-261-6677
Practice Address - Fax:919-261-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care