Healthcare Provider Details

I. General information

NPI: 1821428103
Provider Name (Legal Business Name): ORANGE COUNTY URGENT CARE #3, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78965 HIGHWAY 111
LA QUINTA CA
92253-2072
US

IV. Provider business mailing address

78965 HIGHWAY 111
LA QUINTA CA
92253-2072
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-7847
  • Fax: 760-777-1574
Mailing address:
  • Phone: 760-777-7847
  • Fax: 760-777-1574

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: MR. MICHAEL KYLE BURTNETT
Title or Position: SVP OF OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2153