Provider Demographics
NPI:1346788544
Name:PETERSON URGENT CARE LLC
Entity Type:Organization
Organization Name:PETERSON URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEDOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-258-7632
Mailing Address - Street 1:PO BOX 32522
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5270
Practice Address - Country:US
Practice Address - Phone:830-258-7669
Practice Address - Fax:830-315-1344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETERSON MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-08
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care