Healthcare Provider Details

I. General information

NPI: 1124796362
Provider Name (Legal Business Name): EXECUTIVE URGENT CARE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 04/22/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74785 HWY 111, SUITE 100
INDIAN WELLS CA
92210
US

IV. Provider business mailing address

74785 HWY 111, STE 100
INDIAN WELLS CA
92210
US

V. Phone/Fax

Practice location:
  • Phone: 760-346-3939
  • Fax:
Mailing address:
  • Phone: 760-346-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOHDAN OLESNICKY
Title or Position: CEO
Credential: MD
Phone: 760-464-2131