Provider Demographics
NPI:1659978401
Name:INSTACLINIC, LLC
Entity Type:Organization
Organization Name:INSTACLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SURDAM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:307-421-7277
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-1142
Mailing Address - Country:US
Mailing Address - Phone:307-421-7277
Mailing Address - Fax:
Practice Address - Street 1:7008 QUARTERMILE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1448
Practice Address - Country:US
Practice Address - Phone:307-256-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659978401OtherNPI