Basic Information
| Provider Information | |||||||||
| NPI: | 1821730177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 PURCELL ST | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806013551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036599700 | ||||||||
| FaxNumber: | 7203363989 | ||||||||
| Practice Location | |||||||||
| Address1: | 2241 E ARAPAHOE RD | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801221505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036599700 | ||||||||
| FaxNumber: | 7203363989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | STOCKTON | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3036599700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 31455573 | 05 | CO | MEDICAID |