Healthcare Provider Details

I. General information

NPI: 1073238747
Provider Name (Legal Business Name): MED 360 URGENT CARE NORTHPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 MCFARLAND BLVD
NORTHPORT AL
35476-3135
US

IV. Provider business mailing address

3250 MCFARLAND BLVD STE A
NORTHPORT AL
35476-3135
US

V. Phone/Fax

Practice location:
  • Phone: 205-487-4535
  • Fax: 205-487-8875
Mailing address:
  • Phone: 205-632-3875
  • Fax: 205-462-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FAROUK A RAQUIB
Title or Position: OWNER/ MD
Credential: MD
Phone: 205-326-3875