Provider Demographics
NPI:1962748285
Name:DR PAULS FAMILY & URGENT CARE
Entity type:Organization
Organization Name:DR PAULS FAMILY & URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KATTUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-353-9069
Mailing Address - Street 1:2214 NORTH ATHERTON
Mailing Address - Street 2:STE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2222
Mailing Address - Country:US
Mailing Address - Phone:417-353-9069
Mailing Address - Fax:417-429-2893
Practice Address - Street 1:2214 NORTH ATHERTON
Practice Address - Street 2:STE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2222
Practice Address - Country:US
Practice Address - Phone:417-353-9069
Practice Address - Fax:417-429-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440359261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center