Healthcare Provider Details

I. General information

NPI: 1285731497
Provider Name (Legal Business Name): FIRST STOP URGENT CARE CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 NEW MOODY LN
LAGRANGE KY
40031-9122
US

IV. Provider business mailing address

1006 NEW MOODY LN
LAGRANGE KY
40031-9122
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-0028
  • Fax: 502-222-0029
Mailing address:
  • Phone: 502-222-0028
  • Fax: 502-222-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMLESH C DAVE
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 502-693-2465