Provider Demographics
NPI:1093132821
Name:NEWBURGH URGENT CARE LLC
Entity Type:Organization
Organization Name:NEWBURGH URGENT CARE LLC
Other - Org Name:MERCY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-683-2209
Mailing Address - Street 1:8211 W STATE ROUTE 66
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2534
Mailing Address - Country:US
Mailing Address - Phone:812-490-0463
Mailing Address - Fax:812-490-0469
Practice Address - Street 1:8211 W STATE ROUTE 66
Practice Address - Street 2:SUITE A
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2534
Practice Address - Country:US
Practice Address - Phone:812-490-0463
Practice Address - Fax:812-490-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201218510AMedicaid
ININ1903Medicare PIN