| Organization Name: | OBSIDIAN URGENT CARE, PC |
| NPI Number: | 1255498473 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL J LEONE (PRESIDENT) |
| Mailing Address: | 401 Adams Ave La Grande |
| State: | OR US |
| Postal Code: | 978501619 |
| Phone Number: | 5419627407 |
| Fax Number: | 5419627479 |
| NPI Enumeration Date: | 01/03/2007 |
| NPI Last Update Date: | 09/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 200050027NP-FNP-PP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |