MEDICARE: WELLNOW URGENT CARE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1093120057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNOW URGENT CARE, PC

Provider Business Mailing Address
First Line	:	PO BOX 500
Second Line	:
City	:	ELLICOTTVILLE
State	:	NY
Zip	:	14731-0500
Country	:	US
Telephone Number	:	716-699-9032
Fax Number	:	716-699-9035

Provider Business Practice Location Address
First Line	:	6870 E GENESEE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1031
Country	:	US
Telephone Number	:	315-679-4367
Fax Number	:	315-379-4368

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOHN C RADFORD
Credential	:	MD
Telephone Number	:	716-699-9032

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	06/03/2019

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