Provider Demographics
NPI:1053772152
Name:APPLECARE/MEMORIAL IMMEDIATE CARE JOINT VENTURE LLC
Entity type:Organization
Organization Name:APPLECARE/MEMORIAL IMMEDIATE CARE JOINT VENTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:D
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-349-4945
Mailing Address - Street 1:401 MALL BLVD
Mailing Address - Street 2:SUITE 202E
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4862
Mailing Address - Country:US
Mailing Address - Phone:912-349-4945
Mailing Address - Fax:912-349-4105
Practice Address - Street 1:105 GRAND CENTRAL BLVD STE 108
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4148
Practice Address - Country:US
Practice Address - Phone:912-748-1515
Practice Address - Fax:912-748-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center