Provider Demographics
NPI:1972880813
Name:ADVANCED URGENT CARE OF WILLOW GROVE LLC
Entity Type:Organization
Organization Name:ADVANCED URGENT CARE OF WILLOW GROVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKPARVARFARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-441-4267
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0957
Mailing Address - Country:US
Mailing Address - Phone:570-871-4003
Mailing Address - Fax:866-691-4201
Practice Address - Street 1:126 EASTON RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3203
Practice Address - Country:US
Practice Address - Phone:610-927-5921
Practice Address - Fax:610-898-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty