1497077978 NPI number — M-URGENT CARE LLC

Table of content: (NPI 1497077978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497077978 NPI number — M-URGENT CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M-URGENT CARE LLC
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:
INDIANA UNIVERSITY HEALTH 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:
1497077978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4850 CENTURY PLAZA RD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46254-5476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-216-2828
Provider Business Mailing Address Fax Number:
317-216-2839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11580 OVERLOOK DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46037-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-567-5252
Provider Business Practice Location Address Fax Number:
317-567-5253
Provider Enumeration Date:
02/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BRINK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-216-2520

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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