Healthcare Provider Details

I. General information

NPI: 1609187905
Provider Name (Legal Business Name): ADVANCED URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E COLLEGE AVE
STATE COLLEGE PA
16801-7512
US

IV. Provider business mailing address

PO BOX 957
SCRANTON PA
18501-0957
US

V. Phone/Fax

Practice location:
  • Phone: 814-308-8155
  • Fax: 814-308-8584
Mailing address:
  • Phone: 814-308-8155
  • Fax: 814-308-8584

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

VIII. Authorized Official

Name: DEBORAH VULLINGS
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-927-5921