Provider Demographics
NPI:1962770016
Name:NY URGENT CARE PRACTICE, P.C.
Entity type:Organization
Organization Name:NY URGENT CARE PRACTICE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-699-9032
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0500
Mailing Address - Country:US
Mailing Address - Phone:716-699-9032
Mailing Address - Fax:716-699-9035
Practice Address - Street 1:830 COUNTY ROAD 64
Practice Address - Street 2:#19C
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903-9719
Practice Address - Country:US
Practice Address - Phone:607-846-2030
Practice Address - Fax:607-873-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100063074Medicare PIN