MEDICARE: SILVER STATE IMMEDIATE CARE, LLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1144533738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER STATE IMMEDIATE CARE, LLC

Provider Business Mailing Address
First Line	:	1 JOHN JAMES AUDUBON PKWY
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-1143
Country	:	US
Telephone Number	:	716-204-4500
Fax Number	:	716-204-4501

Provider Business Practice Location Address
First Line	:	1 JOHN JAMES AUDUBON PKWY
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-1143
Country	:	US
Telephone Number	:	716-204-4500
Fax Number	:	716-204-4501

Authorized Official
Title or Position	:	MANAGER
Name	:	GREGORY F DANIEL
Credential	:	M.D.
Telephone Number	:	716-204-4500

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	07/23/2010

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