1275982027 NPI number — URGENT CARE TRAVEL INC

Table of content: (NPI 1275982027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275982027 NPI number — URGENT CARE TRAVEL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE TRAVEL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275982027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9903 SANTA MONICA BLVD STE 4500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90212-1671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-471-3853
Provider Business Mailing Address Fax Number:
310-440-0997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 CASSVILLE WHITE RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30121-7203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-386-0707
Provider Business Practice Location Address Fax Number:
770-386-0799
Provider Enumeration Date:
06/11/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
KATHERINE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
310-471-3753

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)