Healthcare Provider Details

I. General information

NPI: 1760951644
Provider Name (Legal Business Name): PROSPECT URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W PROSPECT RD
ASHTABULA OH
44004-5862
US

IV. Provider business mailing address

PO BOX 933269
CLEVELAND OH
44193-0035
US

V. Phone/Fax

Practice location:
  • Phone: 248-957-7999
  • Fax:
Mailing address:
  • Phone: 248-957-7999
  • 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: FARAH IFTIKHAR
Title or Position: OWNER
Credential: MD
Phone: 248-957-7999