1619445111 NPI number — ORANGE COUNTY URGENT CARE #3, INC.

Table of content: (NPI 1619445111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619445111 NPI number — ORANGE COUNTY URGENT CARE #3, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORANGE COUNTY URGENT CARE #3, 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:
MEDPOST - LAKEWOOD
Provider Other Organization Name Type Code:
3
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:
1619445111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 EASTPARK DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-600-4074
Provider Business Mailing Address Fax Number:
615-309-8341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3559 E. SOUTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-354-4410
Provider Business Practice Location Address Fax Number:
562-316-1410
Provider Enumeration Date:
11/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ENDERLE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-600-4120

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)