Basic Information
Provider Information
NPI: 1659810364
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: 7166999032
FaxNumber: 7166999035
Practice Location
Address1: 5001 STATE HIGHWAY 23
Address2:  
City: ONEONTA
State: NY
PostalCode: 138204508
CountryCode: US
TelephoneNumber: 6073765346
FaxNumber: 6073765347
Other Information
ProviderEnumerationDate: 02/14/2017
LastUpdateDate: 05/31/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RADFORD
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7166999032
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

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

No ID Information.


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