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General NPI Number Information
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NPI Number | 1760951644
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Entity Type | Organization
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Legal Business Name | PROSPECT URGENT CARE LLC
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 417 W PROSPECT RD
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City | ASHTABULA
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State | OH
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Zip | 44004-5862
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Country | US
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Telephone | 248-957-7999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 933269
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City | CLEVELAND
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State | OH
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Zip | 44193-0035
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Country | US
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Telephone | 248-957-7999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARAH IFTIKHAR
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Credential | MD
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Telephone | 248-957-7999
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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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