1356789366 NPI number — URGENT CARE MEDICAL CLINIC, PC

Table of content: (NPI 1356789366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356789366 NPI number — URGENT CARE MEDICAL CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE MEDICAL CLINIC, PC
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:
1356789366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9150 JEWEL LAKE RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99502-5381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-248-8561
Provider Business Mailing Address Fax Number:
907-248-8563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5437 E NORTHERN LIGHTS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-333-8561
Provider Business Practice Location Address Fax Number:
907-333-8560
Provider Enumeration Date:
06/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BEATY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BILLING AGENT
Authorized Official Telephone Number:
907-770-2380

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  242636 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com