MEDICARE: MEDRX 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	:	1699226308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDRX URGENT CARE LLC

Provider Business Mailing Address
First Line	:	60 LORRAINE CT
Second Line	:
City	:	HOLBROOK
State	:	NY
Zip	:	11741-1540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 S MAC ARTHUR LN
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5401
Country	:	US
Telephone Number	:	949-281-9086
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARC RESASCO
Credential	:
Telephone Number	:	949-281-9086

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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