=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801619622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MR URGENT CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6407 S COOPER ST STE 117A
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76001-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-472-7601
-----------------------------------------------------
Fax | 817-472-7213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6407 S COOPER ST STE 117A
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76001-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-472-7601
-----------------------------------------------------
Fax | 817-472-7213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANGER
-----------------------------------------------------
Name | ABDUR REHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-786-2040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------