MEDICARE: HEALING TOUCH 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	OTC 4069	AZ

General Provider Information

NPI Number	:	1508936956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING TOUCH URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE 124
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	480-361-3636
Fax Number	:	480-361-2525

Provider Business Practice Location Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE 124
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	480-361-3636
Fax Number	:	480-361-2525

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GABRIEL UDOCHUKWU OGBONNAYA
Credential	:	M.D., M.H.A.
Telephone Number	:	480-361-3636

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	11/15/2007

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