NPI |
1306104674 |
The fax number associated with the location
address of the provider being identified. |
Entity Type Code |
2 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Employer Identification Number EIN |
|
The date that a record was last updated or changed. |
Provider Organization Name Legal Business Name |
VIRGINIA URGENT CARE PROVIDER NETWORK, LLC |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider First Line Business Practice Location Address |
7332 E BUTHERUS DR |
The first name of the authorized official. |
Provider Second Line Business Practice Location Address |
HANGAR ONE |
The middle name of the authorized official. |
Provider Business Practice Location Address City Name |
SCOTTSDALE |
The title or position of the authorized official. |
Provider Business Practice Location Address State Name |
AZ |
The 10-position telephone number of the authorized official. |
Provider Business Practice Location Address Postal Code |
852602426 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Business Practice Location Address Telephone Number |
8137776453 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Enumeration Date |
4/24/2012 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
4/24/2012 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Authorized Official Last Name |
HORWITZ |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Authorized Official First Name |
LOU |
|
Authorized Official Middle Name |
ELLEN |
The middle name of the authorized official. |
Authorized Official Title or Position |
EXECUTIVE DIRECTOR |
|
Authorized Official Telephone Number |
8137776453 |
|
Healthcare Provider Taxonomy Code 1 |
261QU0200X |
|
Provider License Number 1 |
S395179-7 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
VA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|