MEDICARE: PRN URGENT CARE, INC.

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	:	1366850059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRN URGENT CARE, INC.

Provider Business Mailing Address
First Line	:	191 E ALESSANDRO BLVD STE 9A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5095
Country	:	US
Telephone Number	:	951-780-3300
Fax Number	:	951-780-3303

Provider Business Practice Location Address
First Line	:	191 E ALESSANDRO BLVD STE 9A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5095
Country	:	US
Telephone Number	:	951-780-3300
Fax Number	:	951-780-3303

Authorized Official
Title or Position	:	CEO / OWNER
Name	:	JEAN LACOMBE
Credential	:	PA-C, MPH
Telephone Number	:	951-780-3300

Provider Enumeration Date	:	07/26/2014
Last Update Date	:	07/26/2014

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