1659815256 NPI number — A PLUS WALK-IN URGENT CARE MEDICAL CLINIC, APC

Table of content: (NPI 1659815256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659815256 NPI number — A PLUS WALK-IN URGENT CARE MEDICAL CLINIC, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A PLUS WALK-IN URGENT CARE MEDICAL CLINIC, APC
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:
1659815256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41880 KALMIA ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-8831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-696-7587
Provider Business Mailing Address Fax Number:
951-461-6973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31571 CANYON ESTATES DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LAKE ELSINORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92532-0468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-696-7587
Provider Business Practice Location Address Fax Number:
951-245-8880
Provider Enumeration Date:
12/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KIMES
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
951-696-7587

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)





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