Healthcare Provider Details

I. General information

NPI: 1326641416
Provider Name (Legal Business Name): SOVEREIGN URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 HAMILTON BLVD
TREXLERTOWN PA
18087-9725
US

IV. Provider business mailing address

7150 HAMILTON BLVD SUITE 105 UNIT 400
TREXLERTOWN PA
18087-6005
US

V. Phone/Fax

Practice location:
  • Phone: 610-351-1555
  • Fax: 610-351-1445
Mailing address:
  • Phone: 610-351-1555
  • Fax: 610-351-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GILLIAN O'DONNELL-MORSE
Title or Position: OWNER- CEO
Credential: RN
Phone: 267-226-1181