Provider Demographics
NPI:1083940597
Name:OC URGENTCARE MEDICAL GROUP INCORPORATED
Entity Type:Organization
Organization Name:OC URGENTCARE MEDICAL GROUP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MOUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-508-6131
Mailing Address - Street 1:PO BOX 2638
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0638
Mailing Address - Country:US
Mailing Address - Phone:714-991-5700
Mailing Address - Fax:714-991-5800
Practice Address - Street 1:631 S BROOKHURST ST STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3563
Practice Address - Country:US
Practice Address - Phone:714-991-5700
Practice Address - Fax:714-991-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABUS2009-03901261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083940597Medicaid
CAA106233OtherMEDICAL LICENSE
CADB088AMedicare PIN