Provider Demographics
NPI:1194577841
Name:ICARE VIRTUAL URGENT CARE
Entity type:Organization
Organization Name:ICARE VIRTUAL URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:N
Authorized Official - Last Name:NEBYSHINETS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:559-299-4920
Mailing Address - Street 1:15649 SEQUOIA GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5147
Mailing Address - Country:US
Mailing Address - Phone:559-299-4920
Mailing Address - Fax:
Practice Address - Street 1:15649 SEQUOIA GROVE WAY
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-5147
Practice Address - Country:US
Practice Address - Phone:559-299-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty