1972880813 NPI number — ADVANCED URGENT CARE OF WILLOW GROVE LLC

Table of content: JENNIFER LEIGH YOUNT LCPC (NPI 1770387292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972880813 NPI number — ADVANCED URGENT CARE OF WILLOW GROVE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED URGENT CARE OF WILLOW GROVE 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:
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:
1972880813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 957
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18501-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-871-4003
Provider Business Mailing Address Fax Number:
866-691-4201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 EASTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLOW GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19090-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-927-5921
Provider Business Practice Location Address Fax Number:
610-898-4998
Provider Enumeration Date:
11/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NIKPARVARFARD
Authorized Official First Name:
MEHDI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-441-4267

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD424252 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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