Basic Information
| Provider Information | |||||||||
| NPI: | 1427431055 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDFIRST URGENT CARE PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MASH URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 FOUNTAIN PLZ | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142022211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166918838 | ||||||||
| FaxNumber: | 7168518014 | ||||||||
| Practice Location | |||||||||
| Address1: | 3980 SHERIDAN DR | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142261727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166918838 | ||||||||
| FaxNumber: | 7168518014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | KEARNS | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER CREDENTIALER | ||||||||
| AuthorizedOfficialTelephone: | 7165801830 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 04001869 | 05 | NY | MEDICAID |