NPIMap

Organization Active NPI

Eastern Shore Urgent Care LLC

  • Family Medicine Physician
  • Daphne, AL
National Provider Identifier
1376706275
Registry record updated Jul 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EASTERN SHORE URGENT CARE LLC
Practice address
29710 Urgent Care Drive
Daphne, AL 36526
Phone
(251) 626-3782
NPI assigned
Jul 10, 2008
Last updated
Jul 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2008

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

Authorized official

Name
Michael Mahoney, MDNPI 1396840237
Title
Owner
Phone
(251) 626-3782

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

29710 Urgent Care Drive
Daphne, AL 36526

Mailing address

PO Box 640
Daphne, AL 36526-0640
Phone (251) 602-6996

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090106000100 AL Part B Supplier - Clinic/Group Practice 1951464775 Receives reassigned benefits from 28 practitioners
Practice locations: Daphne, AL

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
01D1084498Eastern Shore Urgent Care29710 Urgent Care Drive, Daphne, AL 36526ComplianceMar 3, 2028

National Provider Directory

National Provider Directory

Locations

29710 Urgent Care Dr
Daphne, AL 36526
Phone (251) 626-3782

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/4349/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1376706275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365260640",
            "telephone_number": "251-602-6996",
            "fax_number": "251-666-8398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29710 URGENT CARE DRIVE",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "36526",
            "telephone_number": "251-626-3782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE URGENT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "MAHONEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-626-3782",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daphne, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; 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.