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NPI Code Detail

MEDICARE: SUPER TRACK URGENT CARE LLC

MEDICARE: SUPER TRACK 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1598289027
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPER TRACK URGENT CARE LLC
Provider Business Mailing Address
First Line : 1050 LAKEWAY DR
Second Line :
City : BELLINGHAM
State : WA
Zip : 98229-2020
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1050 LAKEWAY DR
Second Line :
City : BELLINGHAM
State : WA
Zip : 98229-2020
Country : US
Telephone Number : 360-671-7100
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MAHNAZ LARY
Credential :
Telephone Number : 360-671-7100
Provider Enumeration Date : 07/26/2017
Last Update Date : 11/14/2017

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Directions to “SUPER TRACK URGENT CARE LLC ” Practice Location

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