1427431055 NPI number — MEDFIRST URGENT CARE PLLC

Table of content: (NPI 1427431055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427431055 NPI number — MEDFIRST URGENT CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDFIRST URGENT CARE PLLC
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:
MASH URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1427431055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 FOUNTAIN PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14202-2211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-691-8838
Provider Business Mailing Address Fax Number:
716-851-8014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3980 SHERIDAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-691-8838
Provider Business Practice Location Address Fax Number:
716-851-8014
Provider Enumeration Date:
07/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KEARNS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PROVIDER CREDENTIALER
Authorized Official Telephone Number:
716-580-1830

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04001869 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com