Basic Information
| Provider Information | |||||||||
| NPI: | 1568404325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS URGENT CARE OFFICES MEDICAL GROUP INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOCTORS URGENT CARE OFFICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 935 STATE ROUTE 28 | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451501911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138315955 | ||||||||
| FaxNumber: | 5138315985 | ||||||||
| Practice Location | |||||||||
| Address1: | 3290 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450055692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134227703 | ||||||||
| FaxNumber: | 5134247702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | AMRHEIN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5138315955 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | NOT APPLICABLE | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 36D0344701 | 01 | OH | CLIA WAIVER | OTHER |