MEDICARE: INDUSTRIAL URGENT CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	A90840	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A90840	OTHER	CA	M.D. STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659421287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDUSTRIAL URGENT CARE, INC.

Provider Business Mailing Address
First Line	:	120 W COLE RD
Second Line	:	SUITE B
City	:	CALEXICO
State	:	CA
Zip	:	92231-9700
Country	:	US
Telephone Number	:	760-357-8355
Fax Number	:	760-357-0803

Provider Business Practice Location Address
First Line	:	120 W COLE RD
Second Line	:	SUITE B
City	:	CALEXICO
State	:	CA
Zip	:	92231-9700
Country	:	US
Telephone Number	:	760-357-8355
Fax Number	:	760-357-0803

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES E CREEK
Credential	:	M.D.
Telephone Number	:	760-357-8355

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	01/13/2011

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