Provider Demographics
NPI:1073164455
Name:PANACEA URGENT CARE PA
Entity Type:Organization
Organization Name:PANACEA URGENT CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSOOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-0406
Mailing Address - Street 1:10501 GATEWAY BLVD W STE 105
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7929
Mailing Address - Country:US
Mailing Address - Phone:915-533-0406
Mailing Address - Fax:915-532-1394
Practice Address - Street 1:10501 GATEWAY BLVD W STE 105
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7929
Practice Address - Country:US
Practice Address - Phone:915-533-0406
Practice Address - Fax:915-532-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care