1922316967 NPI number — URGENT CARE SERVICES, INC

Table of content: (NPI 1922316967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922316967 NPI number — URGENT CARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922316967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E 86TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-6382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-769-1670
Provider Business Mailing Address Fax Number:
219-738-6714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1640 45TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-513-0999
Provider Business Practice Location Address Fax Number:
219-513-9032
Provider Enumeration Date:
09/23/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARVEZ
Authorized Official First Name:
SHAHEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-513-0999

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  01039726 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)