Provider Demographics
NPI:1770881229
Name:HAVENS URGENT CARE
Entity type:Organization
Organization Name:HAVENS URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:OPPONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-736-5152
Mailing Address - Street 1:1582 WAGGONER RD
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1582 WAGGONER RD
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004
Practice Address - Country:US
Practice Address - Phone:614-864-1313
Practice Address - Fax:614-864-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000708557OtherANTHEM BC BS
OH000000708557OtherANTHEM BC BS