| Organization Name: | PROVIDENCE URGENT CARE CENTER |
| NPI Number: | 1043237894 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUANITA D ROY (VP FINANCE) |
| Mailing Address: | 22334 W 66th St Spc 10 Shawnee |
| State: | KS US |
| Postal Code: | 662263560 |
| Phone Number: | 9138250909 |
| Fax Number: | 9138250905 |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |