Basic Information
Provider Information
NPI: 1043953557
EntityType: 2
ReplacementNPI:  
OrganizationName: ADVANCED URGENT CARE LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2801 PURCELL ST
Address2:  
City: BRIGHTON
State: CO
PostalCode: 806013551
CountryCode: US
TelephoneNumber: 3036599700
FaxNumber: 7203363989
Practice Location
Address1: 5165 W 72ND AVE
Address2:  
City: WESTMINSTER
State: CO
PostalCode: 800305137
CountryCode: US
TelephoneNumber: 3036599700
FaxNumber: 7203363989
Other Information
ProviderEnumerationDate: 04/14/2022
LastUpdateDate: 04/14/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: EUSER
AuthorizedOfficialFirstName: ELLEN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR OF FINANCE
AuthorizedOfficialTelephone: 3036599700
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: ADVANCED URGENT CARE LLC
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


Home