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General NPI Number Information
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NPI Number | 1871044677
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Entity Type | Organization
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Legal Business Name | MED 360 URGENT CARE, LLC
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 1700 HIGHWAY 78 E
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City | JASPER
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State | AL
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Zip | 35501-4036
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Country | US
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Telephone | 205-512-1058
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Fax | 205-487-8827
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Provider Business Mailing Address
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Address Line | 1700 HIGHWAY 78 E
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City | JASPER
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State | AL
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Zip | 35501-4036
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Country | US
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Telephone | 205-412-5720
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Fax | 205-487-8827
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | MR. FAROUK ANWARUL RAQUIB
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Credential | MD
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Telephone | 205-487-4535
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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 | 170018
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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