Healthcare Provider Details

I. General information

NPI: 1154573095
Provider Name (Legal Business Name): URGI CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12207 HIGHWAY 49
GULFPORT MS
39503-2955
US

IV. Provider business mailing address

200 W RAILROAD ST P. O. BOX 869
LONG BEACH MS
39560-4517
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-0622
  • Fax: 228-864-7958
Mailing address:
  • Phone: 228-864-0622
  • Fax: 228-864-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LYDIA K RAYNER-STOKES
Title or Position: OWNER
Credential:
Phone: 228-864-0622