Provider Demographics
NPI:1033151881
Name:DOCTORS URGENT CARE OFFICES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DOCTORS URGENT CARE OFFICES MEDICAL GROUP INC
Other - Org Name:DOCTORS URGENT CARE OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMRHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-831-5955
Mailing Address - Street 1:935 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1911
Mailing Address - Country:US
Mailing Address - Phone:513-831-5955
Mailing Address - Fax:513-831-5985
Practice Address - Street 1:5915 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3104
Practice Address - Country:US
Practice Address - Phone:937-278-3826
Practice Address - Fax:937-278-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNOT APPLICABLE261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36D0662507OtherCLIA WAIVER
OH36D0662507OtherCLIA WAIVER