=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508636945
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URGENTCHOICE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2024
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2004 W SYCAMORE ST
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46901-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-865-0135
-----------------------------------------------------
Fax | 765-224-0806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2004 W SYCAMORE ST
-----------------------------------------------------
City | KOKOMO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46901-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-865-0135
-----------------------------------------------------
Fax | 765-224-0805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RENEE MARIE GOODRICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-865-0135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------