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NPI Code Detail

MEDICARE: COLLEGE DRIVE URGENT CARE LLC

MEDICARE: COLLEGE DRIVE 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
1261QU0200XUrgent Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1314338OTHERWYBSWY
2314333OTHERWYBLUE CROSS BLUE SHIELD
3315527OTHERWYBSWY
4314332OTHERWYBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1467601765
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLEGE DRIVE URGENT CARE LLC
Provider Business Mailing Address
First Line : 2145 E BASELINE RD STE 303
Second Line :
City : TEMPE
State : AZ
Zip : 85283-1515
Country : US
Telephone Number : 888-705-8558
Fax Number : 480-776-0025
Provider Business Practice Location Address
First Line : 2030 BLUEGRASS CIR
Second Line :
City : CHEYENNE
State : WY
Zip : 82009-7328
Country : US
Telephone Number : 307-635-3500
Fax Number : 307-635-2199
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MR. CHRIS M KANE
Credential :
Telephone Number : 888-705-8558
Provider Enumeration Date : 09/11/2008
Last Update Date : 04/29/2025

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Directions to “COLLEGE DRIVE URGENT CARE LLC ” Practice Location

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