1205368172 NPI number — NIAGARA FALLS URGENT CARE

Table of content: (NPI 1205368172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205368172 NPI number — NIAGARA FALLS URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIAGARA FALLS URGENT CARE
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:
1205368172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3117 MILITARY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14304-4813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-297-2052
Provider Business Mailing Address Fax Number:
716-215-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3117 MILITARY RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14304-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-297-2052
Provider Business Practice Location Address Fax Number:
855-409-5577
Provider Enumeration Date:
03/30/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOM
Authorized Official First Name:
SANTANU
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-661-5621

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X , with the licence number: 242962 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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