1992410187 NPI number — URGENT CARE AT NORTHEAST PHILADELPHIA LLC

Table of content: (NPI 1992410187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992410187 NPI number — URGENT CARE AT NORTHEAST PHILADELPHIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE AT NORTHEAST PHILADELPHIA 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:
NORTHEAST URGENT CARE LLC
Provider Other Organization Name Type Code:
4
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:
1992410187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 COTTMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19149-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-660-9330
Provider Business Mailing Address Fax Number:
215-660-9336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 COTTMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19149-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-660-9330
Provider Business Practice Location Address Fax Number:
215-660-9336
Provider Enumeration Date:
01/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
814-381-5881

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)





Copyright © 2007-2024 www.npivalidator.com