Provider Demographics
NPI:1326641416
Name:SOVEREIGN URGENT CARE INC
Entity Type:Organization
Organization Name:SOVEREIGN URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- CEO
Authorized Official - Prefix:
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL-MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:267-226-1181
Mailing Address - Street 1:7150 HAMILTON BLVD SUITE 105 UNIT 400
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-6005
Mailing Address - Country:US
Mailing Address - Phone:610-351-1555
Mailing Address - Fax:610-351-1445
Practice Address - Street 1:7150 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:TREXLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18087-9725
Practice Address - Country:US
Practice Address - Phone:610-351-1555
Practice Address - Fax:610-351-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty