1043408743 NPI number — MY URBAN CLINIC, INC

Table of content: MS. ALETA LACI SCOTT (NPI 1437393055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043408743 NPI number — MY URBAN CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY URBAN CLINIC, 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:
6
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:
1043408743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 421472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77242-1472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-278-8710
Provider Business Mailing Address Fax Number:
713-278-1910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 N BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62881-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-548-1700
Provider Business Practice Location Address Fax Number:
618-548-1706
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEANS
Authorized Official First Name:
TONEY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-278-8710

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com