Basic Information
| Provider Information | |||||||||
| NPI: | 1609152818 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EMPIRE URGENT CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2115 COMPTON AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928817272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267988600 | ||||||||
| FaxNumber: | 6267988842 | ||||||||
| Practice Location | |||||||||
| Address1: | 2115 COMPTON AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928817272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514930037 | ||||||||
| FaxNumber: | 9512808240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2011 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | JAYASINGHE | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9512807700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.