Healthcare Provider Details

I. General information

NPI: 1619244670
Provider Name (Legal Business Name): CARE 1ST PRIMARY AND URGENT CARE CENTER - LANCASTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44426 10TH ST W A
LANCASTER CA
93534-3325
US

IV. Provider business mailing address

44426 10TH ST W A
LANCASTER CA
93534-3325
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-2400
  • Fax:
Mailing address:
  • Phone: 661-948-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MICHELLE TYSON
Title or Position: MD
Credential: MD
Phone: 661-948-2400