MEDICARE: PVD URGENT 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	:	1215456645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PVD URGENT CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 690804
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-0804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23511 HARDY OAK BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-1928
Country	:	US
Telephone Number	:	210-361-3266
Fax Number	:	210-564-9156

Authorized Official
Title or Position	:	COO
Name	:	LISA VAN DELDEN
Credential	:
Telephone Number	:	210-373-9647

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	05/29/2024

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