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General NPI Number Information
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NPI Number | 1447583141
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Entity Type | Organization
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Legal Business Name | GULFPORT URGENT CARE CENTER LLC
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Dates
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Enumeration Date | 09/12/2009
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Last Update Date | 09/12/2009
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Provider Practice Location Address
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Address Line | 9344 THREE RIVERS RD
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City | GULFPORT
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State | MS
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Zip | 39503-4268
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Country | US
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Telephone | 228-863-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 9344 THREE RIVERS RD
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City | GULFPORT
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State | MS
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Zip | 39503-4268
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Country | US
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Telephone | 228-863-0500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOEL B BURWELL
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Credential | D.O.
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Telephone | 228-863-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 12692
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License Number State | MS
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