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General NPI Number Information
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NPI Number | 1750592036
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Entity Type | Organization
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Legal Business Name | URGENT CARE OF LONG BEACH LLC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 200 W RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4517
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Country | US
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Telephone | 228-864-0622
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Fax | 228-864-7958
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Provider Business Mailing Address
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Address Line | 200 W RAILROAD ST P O BOX 869
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City | LONG BEACH
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State | MS
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Zip | 39560-4517
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Country | US
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Telephone | 228-864-0622
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Fax | 228-864-7958
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYDIA K RAYNER
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Credential |
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Telephone | 228-864-0622
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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