Provider Demographics
NPI:1639765399
Name:TWO RIVERS URGENT CARE AND WELLNESS
Entity Type:Organization
Organization Name:TWO RIVERS URGENT CARE AND WELLNESS
Other - Org Name:TWO RIVERS URGENT CARE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-226-0206
Mailing Address - Street 1:2810 MANATEE AVE EAST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-226-0206
Mailing Address - Fax:941-900-1043
Practice Address - Street 1:2810 MANATEE AVE EAST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-226-0206
Practice Address - Fax:941-900-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care