1235588823 NPI number — FAMILY URGENT CARE LLC

Table of content: (NPI 1235588823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235588823 NPI number — FAMILY URGENT CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY 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:
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:
1235588823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
879 N BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-772-5050
Provider Business Mailing Address Fax Number:
740-772-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 NORTH COURT STREET
Provider Second Line Business Practice Location Address:
FAMILY URGENT CARE, LLC
Provider Business Practice Location Address City Name:
CIRCLEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-772-5050
Provider Business Practice Location Address Fax Number:
740-772-5051
Provider Enumeration Date:
06/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEDORIS
Authorized Official First Name:
LESIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
614-726-0025

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  35080597 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G0088467 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".