Healthcare Provider Details

I. General information

NPI: 1790269751
Provider Name (Legal Business Name): SUPERIOR URGENT CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 GENDER RD
CANAL WINCHESTER OH
43110-8679
US

IV. Provider business mailing address

3620 GENDER RD
CANAL WINCHESTER OH
43110-8679
US

V. Phone/Fax

Practice location:
  • Phone: 614-829-3015
  • Fax:
Mailing address:
  • Phone: 614-829-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STAN BULANOV
Title or Position: OWNER
Credential: CNP
Phone: 614-829-3015