Healthcare Provider Details

I. General information

NPI: 1750926598
Provider Name (Legal Business Name): URGENT CARE NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 12/30/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

IV. Provider business mailing address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

V. Phone/Fax

Practice location:
  • Phone: 901-422-7610
  • Fax:
Mailing address:
  • Phone: 901-422-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID WILLIAM MOEN
Title or Position: PRESIDENT
Credential: MD
Phone: 651-329-2721