Provider Demographics
NPI:1114191954
Name:WELLPOINT URGENT CARE LLC
Entity Type:Organization
Organization Name:WELLPOINT URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-457-7424
Mailing Address - Street 1:3840 EL DORADO HILLS BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3840 EL DORADO HILLS BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4567
Practice Address - Country:US
Practice Address - Phone:916-457-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55172207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty