Provider Demographics
NPI:1992726236
Name:JEFFERSON URGENT CARE, LLC
Entity type:Organization
Organization Name:JEFFERSON URGENT CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:304-728-8543
Mailing Address - Street 1:84 SOMERSET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4827
Mailing Address - Country:US
Mailing Address - Phone:304-728-8543
Mailing Address - Fax:304-728-8644
Practice Address - Street 1:84 SOMERSET BLVD
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4827
Practice Address - Country:US
Practice Address - Phone:304-728-8543
Practice Address - Fax:304-728-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVJE9293381Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER