MEDICARE: URGENT HEALTH CLINIC MEDICAL GROUP 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	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1841370996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT HEALTH CLINIC MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1141 E COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1308
Country	:	US
Telephone Number	:	818-956-1141
Fax Number	:	818-547-4392

Provider Business Practice Location Address
First Line	:	1141 E COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1308
Country	:	US
Telephone Number	:	818-956-1141
Fax Number	:	818-547-4392

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LARRY VIGILIA
Credential	:
Telephone Number	:	818-956-1141

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	05/26/2015

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