Basic Information
Provider Information
NPI: 1376042762
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: 7167206519
FaxNumber: 7166999035
Practice Location
Address1: 7432 NIAGARA FALLS BLVD
Address2:  
City: NIAGARA FALLS
State: NY
PostalCode: 143041716
CountryCode: US
TelephoneNumber: 7163714260
FaxNumber: 7163714261
Other Information
ProviderEnumerationDate: 02/12/2018
LastUpdateDate: 06/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CARDINALE
AuthorizedOfficialFirstName: KIM
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: DIRECTOR OF BILLING
AuthorizedOfficialTelephone: 7166999032
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

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

No ID Information.


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