Provider Demographics
NPI:1679269138
Name:SUPERIOR URGENT CARE, LLC.
Entity Type:Organization
Organization Name:SUPERIOR URGENT CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP, CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BULANOV
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:614-829-3015
Mailing Address - Street 1:3620 GENDER RD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8679
Mailing Address - Country:US
Mailing Address - Phone:614-829-3015
Mailing Address - Fax:833-670-1836
Practice Address - Street 1:3620 GENDER RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8679
Practice Address - Country:US
Practice Address - Phone:614-829-3015
Practice Address - Fax:833-670-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty