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NPI Code Detail

MEDICARE: PHYSICIANS URGENT CARE CENTER, INC.

MEDICARE: PHYSICIANS URGENT CARE CENTER, 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
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CK2751OTHEROKRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831204759
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS URGENT CARE CENTER, INC.
Provider Business Mailing Address
First Line : 1201 E. HARTFORD AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-2018
Country : US
Telephone Number : 580-762-1911
Fax Number : 580-762-0887
Provider Business Practice Location Address
First Line : 1201 E. HARTFORD AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-2018
Country : US
Telephone Number : 580-762-1911
Fax Number : 580-762-0887
Authorized Official
Title or Position : PRESIDENT
Name : AHMAD S. AGHA
Credential : MD
Telephone Number : 580-762-1911
Provider Enumeration Date : 08/20/2006
Last Update Date : 09/22/2015

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