Provider Demographics
NPI:1619278363
Name:5MD CONVENIENT CARE LLC
Entity Type:Organization
Organization Name:5MD CONVENIENT CARE LLC
Other - Org Name:PHYSICIANS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-713-2738
Mailing Address - Street 1:PO BOX 8802
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-8802
Mailing Address - Country:US
Mailing Address - Phone:855-631-4563
Mailing Address - Fax:412-458-3953
Practice Address - Street 1:425 DIERS AVENUE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-389-3278
Practice Address - Fax:308-382-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEPENDINGMedicare PIN
NENA1807Medicare PIN