Provider Demographics
NPI:1033342670
Name:SR URGENT CARE & SPECIALTY CLINIC LLC
Entity Type:Organization
Organization Name:SR URGENT CARE & SPECIALTY CLINIC LLC
Other - Org Name:NW URGENT CARE & SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-713-1666
Mailing Address - Street 1:7322 SW FWY
Mailing Address - Street 2:2000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2010
Mailing Address - Country:US
Mailing Address - Phone:888-713-1666
Mailing Address - Fax:713-682-4644
Practice Address - Street 1:7322 SW FWY
Practice Address - Street 2:2000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2010
Practice Address - Country:US
Practice Address - Phone:888-713-1666
Practice Address - Fax:713-682-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB104713Medicare PIN