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General NPI Number Information
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NPI Number | 1225314412
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Entity Type | Organization
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Legal Business Name | STAY WELL FAMILY & URGENT CARE CLINIC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 3701 GRAPEVINE MILLS PKWY 443
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City | GRAPEVINE
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State | TX
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Zip | 76051-1900
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Country | US
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Telephone | 301-455-5945
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 GRAPEVINE MILLS PKWY 443
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City | GRAPEVINE
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State | TX
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Zip | 76051-1900
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Country | US
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Telephone | 301-455-5945
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ADETUNJI ADESANOYE
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Credential | M.D.
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Telephone | 301-455-5945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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