Provider Demographics
NPI:1679040372
Name:WEST JEFFERSON URGENT CARE
Entity Type:Organization
Organization Name:WEST JEFFERSON URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-405-5611
Mailing Address - Street 1:40 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8125
Mailing Address - Country:US
Mailing Address - Phone:937-405-5611
Mailing Address - Fax:
Practice Address - Street 1:95 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1205
Practice Address - Country:US
Practice Address - Phone:614-879-7100
Practice Address - Fax:614-879-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty