Healthcare Provider Details

I. General information

NPI: 1871044677
Provider Name (Legal Business Name): MED 360 URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HIGHWAY 78 E
JASPER AL
35501-4036
US

IV. Provider business mailing address

1700 HIGHWAY 78 E
JASPER AL
35501-4036
US

V. Phone/Fax

Practice location:
  • Phone: 205-512-1058
  • Fax: 205-487-8827
Mailing address:
  • Phone: 205-412-5720
  • Fax: 205-487-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number170018
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FAROUK ANWARUL RAQUIB
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 205-487-4535