1255813317 NPI number — URGENT CARE TRAVEL, INC

Table of content: (NPI 1255813317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255813317 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:
1255813317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2020
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:
310-471-3753
Provider Business Mailing Address Fax Number:
310-440-0997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 SERVICE LOOP 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MEMPHIS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-333-3419
Provider Business Practice Location Address Fax Number:
870-200-6711
Provider Enumeration Date:
09/05/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
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)

  • Identifier: PENDING , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".