Provider Demographics
NPI:1871112375
Name:PEDIATRIC MEDICAL URGENT CARE SERVICES PLLC
Entity type:Organization
Organization Name:PEDIATRIC MEDICAL URGENT CARE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-207-7840
Mailing Address - Street 1:1 HOLLOW LN STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:718-747-5437
Mailing Address - Fax:516-678-9408
Practice Address - Street 1:2249 MEDICAL CENTER PKWY STE C&D
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4279
Practice Address - Country:US
Practice Address - Phone:629-219-2767
Practice Address - Fax:629-219-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty