Healthcare Provider Details

I. General information

NPI: 1831204759
Provider Name (Legal Business Name): PHYSICIANS URGENT CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E. HARTFORD AVE
PONCA CITY OK
74601-2018
US

IV. Provider business mailing address

1201 E. HARTFORD AVE
PONCA CITY OK
74601-2018
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-1911
  • Fax: 580-762-0887
Mailing address:
  • Phone: 580-762-1911
  • Fax: 580-762-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMAD S. AGHA
Title or Position: PRESIDENT
Credential: MD
Phone: 580-762-1911