MEDICARE: HONEYCREEK 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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1811200322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONEYCREEK URGENT CARE LLC

Provider Business Mailing Address
First Line	:	432 NORTH MAIN STREET
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1427
Country	:	US
Telephone Number	:	937-846-4000
Fax Number	:	937-846-4004

Provider Business Practice Location Address
First Line	:	432 N MAIN ST
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1427
Country	:	US
Telephone Number	:	937-846-4000
Fax Number	:	937-846-4004

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ASHOK P DEVATHA
Credential	:	M.D.
Telephone Number	:	937-846-4000

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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Directions to “HONEYCREEK URGENT CARE LLC ” Practice Location

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