=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144273194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORENO VALLEY URGENT CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 10/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24318 HEMLOCK AVE SUITE # E1
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92557-7222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-243-5050
-----------------------------------------------------
Fax | 951-234-5586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24318 HEMLOCK AVE SUITE # E1
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92557-7222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-243-5050
-----------------------------------------------------
Fax | 951-234-5586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES A HARRISON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 951-243-5050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | A43499
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------