Healthcare Provider Details

I. General information

NPI: 1407182587
Provider Name (Legal Business Name): ADVANCED URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MULBERRY STREET
SCRANTON PA
18503
US

IV. Provider business mailing address

PO BOX 957
SCRANTON PA
18501-0957
US

V. Phone/Fax

Practice location:
  • Phone: 570-909-9972
  • Fax: 570-955-0267
Mailing address:
  • Phone: 570-871-4005
  • Fax: 570-955-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberMD424252
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MEHDI NIKPARVARFARD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 570-871-4005