MEDICARE: YOUR URGENT CARE OF TEXAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1043657034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR URGENT CARE OF TEXAS LLC

Provider Business Mailing Address
First Line	:	15119 WALLISVILLE RD STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4629
Country	:	US
Telephone Number	:	832-544-8276
Fax Number	:

Provider Business Practice Location Address
First Line	:	15119 WALLISVILLE RD STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-4629
Country	:	US
Telephone Number	:	832-544-8276
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KASHIF ANSARI
Credential	:	M.D.
Telephone Number	:	832-544-8276

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/31/2013

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