=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871038786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URGENT CARE TRAVEL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2016
-----------------------------------------------------
Last Update Date | 02/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1876 EAST FWY # C
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-238-0797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9903 SANTA MONICA BLVD STE 4500
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-1671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-471-3753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. DEBORAH MITCHELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-471-3753
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------