MEDICARE: PVD URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1033652110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PVD URGENT CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 690804
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-0804
Country	:	US
Telephone Number	:	210-530-1235
Fax Number	:	210-530-1187

Provider Business Practice Location Address
First Line	:	18007 W IH 10
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-9536
Country	:	US
Telephone Number	:	210-530-1040
Fax Number	:	210-530-1187

Authorized Official
Title or Position	:	CEO
Name	:	PETER VAN DELDEN
Credential	:	MD
Telephone Number	:	210-530-1257

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	05/29/2024

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