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General NPI Number Information
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NPI Number | 1639765399
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Entity Type | Organization
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Legal Business Name | TWO RIVERS URGENT CARE AND WELLNESS
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 2810 MANATEE AVE EAST
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City | BRADENTON
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State | FL
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Zip | 34208
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Country | US
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Telephone | 941-226-0206
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Fax | 941-900-1043
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Provider Business Mailing Address
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Address Line | 2810 MANATEE AVE EAST
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City | BRADENTON
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State | FL
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Zip | 34208
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Country | US
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Telephone | 941-226-0206
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Fax | 941-900-1043
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Authorized Official
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Title or Position | MD/OWNER
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Name | MR. JAYA K KOLLA
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Credential | MD
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Telephone | 941-226-0206
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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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