1386155919 NPI number — GRAND VIEW URGENT CARE, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386155919 NPI number — GRAND VIEW URGENT CARE, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND VIEW 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:
1386155919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 829616
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:
19182-9616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-808-6625
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 QUAKERS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUAKERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-453-5620
Provider Business Practice Location Address Fax Number:
215-453-4197
Provider Enumeration Date:
10/23/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KEEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. VICE PRESIDENT/C.F.O.
Authorized Official Telephone Number:
215-453-4604

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)