Healthcare Provider Details

I. General information

NPI: 1962748285
Provider Name (Legal Business Name): DR PAULS FAMILY & URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 NORTH ATHERTON STE 100
STATE COLLEGE PA
16803-2222
US

IV. Provider business mailing address

2214 NORTH ATHERTON STE 100
STATE COLLEGE PA
16803-2222
US

V. Phone/Fax

Practice location:
  • Phone: 417-353-9069
  • Fax: 417-429-2893
Mailing address:
  • Phone: 417-353-9069
  • Fax: 417-429-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD440359
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: PAUL KATTUPALLI
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 417-353-9069