Provider Demographics
NPI:1114240371
Name:FAMILY MEDICAL CLINIC & URGENT CARE INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CLINIC & URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-868-1990
Mailing Address - Street 1:9723 SIERRA VISTA RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-8271
Mailing Address - Country:US
Mailing Address - Phone:760-868-1990
Mailing Address - Fax:760-868-1201
Practice Address - Street 1:9723 SIERRA VISTA RD
Practice Address - Street 2:UNIT A
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-8271
Practice Address - Country:US
Practice Address - Phone:760-868-1990
Practice Address - Fax:760-868-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61054261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center