Healthcare Provider Details

I. General information

NPI: 1689120529
Provider Name (Legal Business Name): BRECK URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W US 60
IRVINGTON KY
40146
US

IV. Provider business mailing address

PO BOX 147
IRVINGTON KY
40146-0147
US

V. Phone/Fax

Practice location:
  • Phone: 270-547-7161
  • Fax: 270-547-7163
Mailing address:
  • Phone: 270-547-7161
  • Fax: 270-547-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SURYA PATEL
Title or Position: OWNER
Credential: M.D.
Phone: 270-547-7161