Healthcare Provider Details

I. General information

NPI: 1194057505
Provider Name (Legal Business Name): GRONDEL URGENT CARE OF HENDERSON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10561 JEFFREYS ST SUITE 100
HENDERSON NV
89052-4266
US

IV. Provider business mailing address

PO BOX 629
ALTOONA IA
50009-0629
US

V. Phone/Fax

Practice location:
  • Phone: 702-478-5620
  • Fax: 702-478-5093
Mailing address:
  • Phone: 515-645-9911
  • Fax: 515-967-5581

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: GORDON BRUINSMA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 616-293-4769