=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194365932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY URGENT CARE PLUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2020
-----------------------------------------------------
Last Update Date | 09/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5082 GLENCROSSING WAY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45238-3360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-226-4325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1018 TOWANDA TER
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45216-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-978-1075
-----------------------------------------------------
Fax | 513-978-1335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. JAIMEE KENYATTA COLVIN
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 513-704-4788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------