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General NPI Number Information
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NPI Number | 1245628494
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Entity Type | Organization
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Legal Business Name | VALLEY FORGE URGENT CARE
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 2521 W MAIN ST
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City | NORRISTOWN
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State | PA
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Zip | 19403-3093
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Country | US
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Telephone | 610-539-3221
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Fax | 610-539-3222
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Provider Business Mailing Address
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Address Line | 2521 W MAIN ST
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City | NORRISTOWN
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State | PA
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Zip | 19403-3093
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Country | US
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Telephone | 610-539-3221
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Fax | 610-539-3222
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | AYN LARSON
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Credential | MMS, PA-C
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Telephone | 610-539-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MAO57354
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License Number State | PA
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