Provider Demographics
NPI:1023751773
Name:DOMINION URGENT CARE CLINIC LLC
Entity type:Organization
Organization Name:DOMINION URGENT CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OPOKU
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:614-330-9150
Mailing Address - Street 1:2515 W SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8956
Mailing Address - Country:US
Mailing Address - Phone:614-394-9646
Mailing Address - Fax:
Practice Address - Street 1:2515 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8956
Practice Address - Country:US
Practice Address - Phone:614-394-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOMINION HEALTH SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care