Healthcare Provider Details

I. General information

NPI: 1033459094
Provider Name (Legal Business Name): FAMILY URGENT CARE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 PITTSTON AVE LEFT BUILDING
SCRANTON PA
18505-1651
US

IV. Provider business mailing address

1831 PITTSTON AVE LEFT BUILDING
SCRANTON PA
18505-1651
US

V. Phone/Fax

Practice location:
  • Phone: 570-507-9517
  • Fax: 570-507-9520
Mailing address:
  • Phone: 570-507-9517
  • Fax: 570-507-9520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RAJAA NEBBARI
Title or Position: TAX MATTERS MEMBER
Credential: M.D.
Phone: 570-780-4552