Provider Demographics
NPI:1063686301
Name:AVALON URGENT CARE
Entity Type:Organization
Organization Name:AVALON URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-579-7557
Mailing Address - Street 1:805 HILL BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1482
Mailing Address - Country:US
Mailing Address - Phone:817-579-7557
Mailing Address - Fax:817-579-6166
Practice Address - Street 1:805 HILL BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1482
Practice Address - Country:US
Practice Address - Phone:817-579-7557
Practice Address - Fax:817-579-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care