Provider Demographics
NPI:1033652110
Name:PVD URGENT CARE LLC
Entity Type:Organization
Organization Name:PVD URGENT CARE LLC
Other - Org Name:THE RIM URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-530-1257
Mailing Address - Street 1:PO BOX 690804
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0804
Mailing Address - Country:US
Mailing Address - Phone:210-530-1235
Mailing Address - Fax:210-530-1187
Practice Address - Street 1:18007 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9536
Practice Address - Country:US
Practice Address - Phone:210-530-1235
Practice Address - Fax:210-530-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care