Provider Demographics
NPI:1205475001
Name:WOODRUFF ROAD URGENT CARE CENTER, P.C.
Entity type:Organization
Organization Name:WOODRUFF ROAD URGENT CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-307-8672
Mailing Address - Street 1:PO BOX 645576
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-5576
Mailing Address - Country:US
Mailing Address - Phone:864-307-8840
Mailing Address - Fax:864-307-8841
Practice Address - Street 1:3613 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:POWDERSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7516
Practice Address - Country:US
Practice Address - Phone:864-307-8840
Practice Address - Fax:864-307-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care