MEDICARE: SONIC URGENT CARE, PLLC

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1255841540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONIC URGENT CARE, PLLC

Provider Business Mailing Address
First Line	:	406 N MAIN ST STE 170
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1850
Country	:	US
Telephone Number	:	617-244-3322
Fax Number	:	866-851-5773

Provider Business Practice Location Address
First Line	:	406 N MAIN ST STE 170
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1850
Country	:	US
Telephone Number	:	617-244-3322
Fax Number	:	866-851-5773

Authorized Official
Title or Position	:	OWNER
Name	:	OSAZEE OSAGIE
Credential	:	MD
Telephone Number	:	617-244-3322

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	10/02/2017

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