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General NPI Number Information
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NPI Number | 1417280884
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Entity Type | Organization
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Legal Business Name | UNIVERSITY CITY URGENT CARE CLINIC INC
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 1201 STARK ROAD
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City | STARKVILLE
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State | MS
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Zip | 39760
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Country | US
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Telephone | 662-324-9760
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Fax | 662-324-9761
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Provider Business Mailing Address
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Address Line | PO BOX 845 1201 STARK ROAD
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City | STARKVILLE
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State | MS
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Zip | 39760-0845
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Country | US
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Telephone | 662-324-9760
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Fax | 662-324-9761
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Authorized Official
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Title or Position | CEO
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Name | MS. MARY BETH HILLMAN
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Credential |
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Telephone | 662-324-9760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 06420
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License Number State | MS
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