Healthcare Provider Details
I. General information
NPI: 1407302367
Provider Name (Legal Business Name): WEST END PEDIATRIC URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/31/2016
Last Update Date: 08/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1800 ENGLISH ROAD SUITE 2
ROCHESTER NY
14616-1691
US
IV. Provider business mailing address
1800 ENGLISH ROAD SUITE 2
ROCHESTER NY
14616-1691
US
V. Phone/Fax
- Phone: 585-286-9595
- Fax: 585-286-9598
- Phone: 585-286-9595
- Fax: 585-286-9598
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QU0200X |
| Taxonomy | Urgent Care Clinic/Center |
| License Number | 209616 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QU0200X |
| Taxonomy | Urgent Care Clinic/Center |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207PP0204X |
| Taxonomy | Pediatric Emergency Medicine (Emergency Medicine) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
KEVIN
GEORGE
O'GARA
Title or Position: SOLE OWNER
Credential: MD
Phone: 585-797-5422