Basic Information
| Provider Information | |||||||||
| NPI: | 1851915680 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEVADA URGENT CARE NETWORK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 367 S GULPH RD | ||||||||
| Address2: | ATTN IPM CREDENTIALING | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194063121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103824943 | ||||||||
| FaxNumber: | 6108783965 | ||||||||
| Practice Location | |||||||||
| Address1: | 5265 VISTA BLVD BLDG B | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894360836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103824943 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2020 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP - PHYS OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6103824943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.