Wal-Mart Stores East, LP
Nurse Practitioner in North Augusta, SC. Organization (NPI-2).
NPI number1922415165
StatusActive
Last updated in NPPESFeb 19, 2015
Details
- NPI
- 1922415165
- Entity type
- Organization (NPI-2)
- Legal business name
- Wal-Mart Stores East, LP
- Organization subpart
- Yes
- Enumeration date
- Jul 21, 2014
- Last updated
- Feb 19, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | – | – | Yes |
Other names
- Walmart Care Clinics 10-1270 (Other Name)
Practice location
1201 Knox AveNorth Augusta, SC 29841-4056
Phone 803-426-5087 · Fax 803-202-8705
Mailing address
702 Sw 8th StBentonville, AR 72716-0445
Phone 479-204-8550
Authorized official
Laura Levine
Director Of Healthcare Contracting
4792048550
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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