Provider Demographics
NPI:1891143806
Name:DYNAMIC URGENT CARE
Entity Type:Organization
Organization Name:DYNAMIC URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DHAVAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:725-200-3232
Mailing Address - Street 1:2435 FIRE MESA ST
Mailing Address - Street 2:STE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9009
Mailing Address - Country:US
Mailing Address - Phone:725-200-3232
Mailing Address - Fax:725-200-3233
Practice Address - Street 1:2435 FIRE MESA ST
Practice Address - Street 2:STE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9009
Practice Address - Country:US
Practice Address - Phone:725-200-3232
Practice Address - Fax:725-200-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12305261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCD534AMedicare UPIN
NVCD532ZMedicare PIN