Basic Information
Provider Information | |||||||||
NPI: | 1063998649 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WELLNOW URGENT CARE, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WELLNOW URGENT CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 500 | ||||||||
Address2: |   | ||||||||
City: | ELLICOTTVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 147310500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7166999032 | ||||||||
FaxNumber: | 7166999035 | ||||||||
Practice Location | |||||||||
Address1: | 18 COURTNEY DR | ||||||||
Address2: |   | ||||||||
City: | FAIRPORT | ||||||||
State: | NY | ||||||||
PostalCode: | 144503338 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5854217537 | ||||||||
FaxNumber: | 5854217538 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2018 | ||||||||
LastUpdateDate: | 03/05/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RADFORD | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR REVENUE CYCLE MANAGEMENT | ||||||||
AuthorizedOfficialTelephone: | 7166999032 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NY URGENT CARE PRACTICE PC | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/05/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.