Healthcare Provider Details

I. General information

NPI: 1952817280
Provider Name (Legal Business Name): ORANGE COUNTY URGENT CARE #3 INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 12/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82151 AVENUE 42 STE 100
INDIO CA
92203-9312
US

IV. Provider business mailing address

115 EASTPARK DR STE 300
BRENTWOOD TN
37027-2311
US

V. Phone/Fax

Practice location:
  • Phone: 615-600-4074
  • Fax:
Mailing address:
  • Phone: 615-600-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC ENDERLE
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 615-600-4120