Provider Demographics
NPI:1558531467
Name:EAST SIDE URGENT CARE LLC
Entity Type:Organization
Organization Name:EAST SIDE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:401-578-8836
Mailing Address - Street 1:1195 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1824
Mailing Address - Country:US
Mailing Address - Phone:401-861-3782
Mailing Address - Fax:
Practice Address - Street 1:1195 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1824
Practice Address - Country:US
Practice Address - Phone:401-861-3782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care