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General NPI Number Information
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NPI Number | 1700057403
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Entity Type | Organization
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Legal Business Name | URGENT CARE CENTER
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 3010 MAPLE AVE
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City | ALTOONA
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State | PA
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Zip | 16601-1736
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Country | US
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Telephone | 814-943-6111
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Fax | 814-943-6118
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Provider Business Mailing Address
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Address Line | 3010 MAPLE AVE
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City | ALTOONA
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State | PA
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Zip | 16601-1736
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Country | US
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Telephone | 814-943-6111
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Fax | 814-943-6118
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSEPH F MARRA JR.
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Credential | C.R.N.P.
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Telephone | 814-943-6111
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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 | SP007906
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License Number State | PA
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