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General NPI Number Information
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NPI Number | 1619278363
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Entity Type | Organization
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Legal Business Name | 5MD CONVENIENT CARE LLC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 425 DIERS AVENUE
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City | GRAND ISLAND
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State | NE
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Zip | 68803
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Country | US
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Telephone | 308-389-3278
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Fax | 308-382-1149
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Provider Business Mailing Address
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Address Line | PO BOX 8802
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City | CAROL STREAM
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State | IL
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Zip | 60197-8802
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Country | US
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Telephone | 855-631-4563
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Fax | 412-458-3953
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Authorized Official
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Title or Position | MD / OWNER
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Name | DR. TERRY BUZZARD
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Credential | MD
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Telephone | 815-713-2738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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