MEDICARE: FAMILY FIRST URGENT CARE PLLC

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	:	1639506876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	2116 E RUSK ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 E RUSK ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9052
Country	:	US
Telephone Number	:	903-284-6105
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER/MEMBER
Name	:	JUSTIN MCINNIS
Credential	:	MD
Telephone Number	:	903-284-6105

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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