Provider Demographics
NPI:1225314412
Name:STAY WELL FAMILY & URGENT CARE CLINIC
Entity Type:Organization
Organization Name:STAY WELL FAMILY & URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADETUNJI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADESANOYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-455-5945
Mailing Address - Street 1:3701 GRAPEVINE MILLS PKWY
Mailing Address - Street 2:443
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1900
Mailing Address - Country:US
Mailing Address - Phone:301-455-5945
Mailing Address - Fax:
Practice Address - Street 1:3701 GRAPEVINE MILLS PKWY
Practice Address - Street 2:443
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-1900
Practice Address - Country:US
Practice Address - Phone:301-455-5945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care