MEDICARE: ADVANCED URGENT CARE OF AMERICA INC.

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	:	1811269517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED URGENT CARE OF AMERICA INC.

Provider Business Mailing Address
First Line	:	3202 LAKE ARIEL HWY
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-7602
Country	:	US
Telephone Number	:	251-414-5810
Fax Number	:	251-414-5809

Provider Business Practice Location Address
First Line	:	3202 LAKE ARIEL HWY
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-7602
Country	:	US
Telephone Number	:	251-414-5810
Fax Number	:	251-414-5809

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	AMY COLLINS
Credential	:
Telephone Number	:	251-414-5810

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2012

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