MEDICARE: URGENT CARE MEDICAL, P.C.

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	202905	NY

General Provider Information

NPI Number	:	1073996211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT CARE MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	11201 75TH AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5633
Country	:	US
Telephone Number	:	718-268-6808
Fax Number	:	718-268-6858

Provider Business Practice Location Address
First Line	:	11201 75TH AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5633
Country	:	US
Telephone Number	:	718-268-6808
Fax Number	:	718-268-6858

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. WAIHO LUM
Credential	:	MD
Telephone Number	:	718-268-6808

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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