Healthcare Provider Details

I. General information

NPI: 1043947955
Provider Name (Legal Business Name): COLUMBUS URGENT CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W DALLAS ST
CONROE TX
77301-2248
US

IV. Provider business mailing address

804 W DALLAS ST
CONROE TX
77301-2248
US

V. Phone/Fax

Practice location:
  • Phone: 936-494-0865
  • Fax: 936-494-0057
Mailing address:
  • Phone: 936-494-0865
  • Fax: 936-494-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDUR RAUF
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 713-893-6214