Healthcare Provider Details

I. General information

NPI: 1578613188
Provider Name (Legal Business Name): URGENT MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 GOODMAN RD W
SOUTHAVEN MS
38671-9405
US

IV. Provider business mailing address

176 GOODMAN RD W
SOUTHAVEN MS
38671-9405
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-1020
  • Fax:
Mailing address:
  • Phone: 662-536-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15476
License Number StateMS

VIII. Authorized Official

Name: DR. ACHIN SHARMA
Title or Position: PHYSICIAN
Credential: MD
Phone: 662-536-1020