Healthcare Provider Details

I. General information

NPI: 1548504053
Provider Name (Legal Business Name): URGENT HEALTH CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N 3RD ST SUITE B
MCCALL ID
83638-4414
US

IV. Provider business mailing address

PO BOX 2603
MCCALL ID
83638-2603
US

V. Phone/Fax

Practice location:
  • Phone: 208-315-4390
  • Fax:
Mailing address:
  • Phone: 208-315-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberM-11371
License Number StateID

VIII. Authorized Official

Name: DR. JOHN ALAN HOLLEY
Title or Position: MEDICAL DIRECTOR
Credential: M.D,
Phone: 208-315-4390