=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699599290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCEL URGENT CARE OF PA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2024
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 S BROAD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19147-2169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-565-3700
-----------------------------------------------------
Fax | 845-565-3696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 484 TEMPLE HILL RD STE 102
-----------------------------------------------------
City | NEW WINDSOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12553-5529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-565-3700
-----------------------------------------------------
Fax | 845-565-3696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED MEMBER
-----------------------------------------------------
Name | ANTHONY F RUVO
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 914-466-9472
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------