1639680317 NPI number — GRAND VIEW URGENT CARE

Table of content: (NPI 1639680317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639680317 NPI number — GRAND VIEW URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND VIEW 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:
6
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:
1639680317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 HORIZON CIRCLE SUITE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHALFONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-453-5610
Provider Business Mailing Address Fax Number:
215-453-4012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 HORIZON CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHALFONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18914-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-453-5610
Provider Business Practice Location Address Fax Number:
215-453-4012
Provider Enumeration Date:
10/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HOWENSTEIN
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR
Authorized Official Telephone Number:
215-453-4942

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2172249 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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