Provider Demographics
NPI:1033787593
Name:COUNTRYWIDE URGENT CARE & MINOR EMERGENCY, LLC
Entity Type:Organization
Organization Name:COUNTRYWIDE URGENT CARE & MINOR EMERGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-975-0001
Mailing Address - Street 1:9135 KATY FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1636
Mailing Address - Country:US
Mailing Address - Phone:832-378-8990
Mailing Address - Fax:
Practice Address - Street 1:9135 KATY FWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1636
Practice Address - Country:US
Practice Address - Phone:832-378-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care