MEDICARE: CITY DOC UPTOWN URGENT CARE CENTER, 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	:	1679686349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY DOC UPTOWN URGENT CARE CENTER, PLLC

Provider Business Mailing Address
First Line	:	2909 MCKINNEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-4713
Country	:	US
Telephone Number	:	214-871-7000
Fax Number	:	214-871-7020

Provider Business Practice Location Address
First Line	:	2909 MCKINNEY AVE
Second Line	:	SUIT B
City	:	DALLAS
State	:	TX
Zip	:	75204-2412
Country	:	US
Telephone Number	:	214-871-7000
Fax Number	:	214-871-7020

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KYLE DELP
Credential	:
Telephone Number	:	214-871-7000

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/09/2012

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