Basic Information
| Provider Information | |||||||||
| NPI: | 1649201286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHERWOOD URGENT CARE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 610 SHEPHERD WAY | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686831 | ||||||||
| FaxNumber: | 5012792402 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 SHEPHERD WAY | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686831 | ||||||||
| FaxNumber: | 5012792402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | SHERWOOD | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5012686831 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5738270001 | 01 | AR | MEDICARE DME | OTHER | 175717002 | 05 | AR | MEDICAID |