Basic Information
| Provider Information | |||||||||
| NPI: | 1821492935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WYOMING URGENT CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WARSAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145691329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857860101 | ||||||||
| FaxNumber: | 5857863505 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WARSAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145691329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857860101 | ||||||||
| FaxNumber: | 5857863505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2014 | ||||||||
| LastUpdateDate: | 10/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | GERMAIN | ||||||||
| AuthorizedOfficialFirstName: | LESLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5857860101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 171396 | NY | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QU0200X | 208844 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.