MEDICARE: ANAHEIM 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	:	1457842635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANAHEIM URGENT CARE, INC

Provider Business Mailing Address
First Line	:	831 S STATE COLLEGE BLVD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-4613
Country	:	US
Telephone Number	:	714-533-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 N FAIRFAX AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-7261
Country	:	US
Telephone Number	:	323-957-2273
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JAMALA PRATT
Credential	:
Telephone Number	:	714-533-2273

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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