MEDICARE: URGENT CARE CENTER OF FOLSOM

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	207Q00000X	Family Medicine Physician	G63628	CA

General Provider Information

NPI Number	:	1194791715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT CARE CENTER OF FOLSOM

Provider Business Mailing Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	SUITE 1400
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-984-8244
Fax Number	:	916-984-8207

Provider Business Practice Location Address
First Line	:	1600 CREEKSIDE DR
Second Line	:	SUITE 1400
City	:	FOLSOM
State	:	CA
Zip	:	95630-3444
Country	:	US
Telephone Number	:	916-984-8244
Fax Number	:	916-984-8207

Authorized Official
Title or Position	:	OFFICE SUPERVISOR
Name	:	DEBBIE WHERRY
Credential	:
Telephone Number	:	916-984-8244

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/30/2010

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Directions to “URGENT CARE CENTER OF FOLSOM ” Practice Location

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