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General NPI Number Information
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NPI Number | 1083101240
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Entity Type | Organization
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Legal Business Name | MAN O WAR URGENT CARE LLC
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 4097 NICHOLS PARK DR STE 108
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-523-5310
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Fax | 859-523-5312
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | BEREA
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State | KY
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Zip | 40403-0429
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Country | US
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Telephone | 859-523-5310
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Fax | 859-523-5312
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Authorized Official
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Title or Position | OWNER
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Name | NAWAR SODA
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Credential | MD
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Telephone | 859-523-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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