Provider Demographics
NPI:1700057403
Name:URGENT CARE CENTER
Entity Type:Organization
Organization Name:URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNP
Authorized Official - Phone:814-943-6111
Mailing Address - Street 1:3010 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1736
Mailing Address - Country:US
Mailing Address - Phone:814-943-6111
Mailing Address - Fax:814-943-6118
Practice Address - Street 1:3010 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1736
Practice Address - Country:US
Practice Address - Phone:814-943-6111
Practice Address - Fax:814-943-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007906261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015127860002Medicaid
PA1015127860002Medicaid