Provider Demographics
NPI:1679143655
Name:MOBILE URGENT SPECIALIZED TREATMENT CLINIC
Entity type:Organization
Organization Name:MOBILE URGENT SPECIALIZED TREATMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:ALECIA
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-988-6878
Mailing Address - Street 1:5710 W GATE CITY BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7047
Mailing Address - Country:US
Mailing Address - Phone:336-988-6878
Mailing Address - Fax:
Practice Address - Street 1:5309 HIGHSTREAM CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407
Practice Address - Country:US
Practice Address - Phone:336-988-6878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty