Provider Demographics
NPI:1023110228
Name:ROCKY RIVER URGENT CARE, INC.
Entity type:Organization
Organization Name:ROCKY RIVER URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-356-5500
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-356-9844
Mailing Address - Fax:440-356-0660
Practice Address - Street 1:19895 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1815
Practice Address - Country:US
Practice Address - Phone:440-356-5500
Practice Address - Fax:440-356-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2183042Medicaid
OH2183042Medicaid
OH=========00OtherBWC