MEDICARE: URBAN HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	363A00000X	Physician Assistant
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0011RB	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275716110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	2837 CLINTON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-8401
Country	:	US
Telephone Number	:	713-923-2273
Fax Number	:	713-923-2276

Provider Business Practice Location Address
First Line	:	5616 LAWNDALE ST
Second Line	:	SUITE A-203
City	:	HOUSTON
State	:	TX
Zip	:	77023-3840
Country	:	US
Telephone Number	:	713-923-2273
Fax Number	:	713-923-2276

Authorized Official
Title or Position	:	MANAGER
Name	:	JASON T URTIS
Credential	:
Telephone Number	:	713-923-2273

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	07/02/2008

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Directions to “URBAN HEALTHCARE, LLC ” Practice Location

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