Basic Information
| Provider Information | |||||||||
| NPI: | 1487601167 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEDGEWOOD URGENT CARE, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 COPELAND MILL RD | ||||||||
| Address2: | SUITE 1D | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147940481 | ||||||||
| FaxNumber: | 6147943711 | ||||||||
| Practice Location | |||||||||
| Address1: | 10330 SAWMILL PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | POWELL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430657790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149239200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | ORTH | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6148395233 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2704747 | 05 | OH | MEDICAID |