NPIMap

Organization Active NPI

Medac Health Services, PA

Doing business as Medac Urgent Care

  • Emergency Medicine Physician
  • Wilmington, NC
National Provider Identifier
1356345920
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MEDAC HEALTH SERVICES, PA
Doing business as
Medac Urgent Care
Practice address
4402 Shipyard Blvd
Wilmington, NC 28403
Phone
(910) 791-0075
Fax
(910) 791-5359
NPI assigned
Jun 10, 2005
Last updated
Oct 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Maloney
Title
Ceo
Phone
(616) 656-2750

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Urgent Care Clinic/Center 261QU0200X NU

Addresses

Primary practice location

4402 Shipyard Blvd
Wilmington, NC 28403

Mailing address

216 Centerview Dr
Brentwood, TN 37027-3226
Phone (910) 791-0075

Other identifiers 2

IdentifierTypeStateIssuer
07651OtherNCBCBS
CC2877OtherNCRAILROAD MEDICARE

Other names 1

  • Medac Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040312000319 NC Part B Supplier - Clinic/Group Practice 1254220809 Receives reassigned benefits from 32 practitioners
Practice locations: Wilmington, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0245857Medac Health Services, PD Dba Medac Shipyard4402 Shipyard Boulevard, Wilmington, NC 28403Certificate of waiverMar 6, 2027

National Provider Directory

National Provider Directory

Locations

4402 Shipyard Blvd
#T
Wilmington, NC 28403

8115 Market St
Ste 100
Wilmington, NC 28411
Phone (910) 256-6088

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1356345920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 CENTERVIEW DR",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370273226",
            "telephone_number": "910-791-0075",
            "fax_number": "910-791-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28403",
            "telephone_number": "910-791-0075",
            "fax_number": "910-791-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDAC HEALTH SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "MALONEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-656-2750"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07651",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC2877",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medac Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medac Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.