Provider Demographics
NPI:1164449971
Name:VENTURA URGENT CARE CENTER MEDICAL CORP
Entity Type:Organization
Organization Name:VENTURA URGENT CARE CENTER MEDICAL CORP
Other - Org Name:VENTURA UGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:805-658-2273
Mailing Address - Street 1:5725 RALSTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6053
Mailing Address - Country:US
Mailing Address - Phone:805-658-2273
Mailing Address - Fax:805-639-9446
Practice Address - Street 1:5725 RALSTON ST STE 101
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6053
Practice Address - Country:US
Practice Address - Phone:805-658-2273
Practice Address - Fax:805-639-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14141OtherPTAN
CAW14141OtherPTAN