Provider Demographics
NPI:1164749339
Name:URGENT CARE CLINIC OF NFC
Entity Type:Organization
Organization Name:URGENT CARE CLINIC OF NFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-379-2647
Mailing Address - Street 1:207 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:TX
Mailing Address - Zip Code:75966-3203
Mailing Address - Country:US
Mailing Address - Phone:409-384-1700
Mailing Address - Fax:409-384-1701
Practice Address - Street 1:1250 MARVIN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4934
Practice Address - Country:US
Practice Address - Phone:409-384-1700
Practice Address - Fax:409-384-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8465261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22233Medicare UPIN
TX8CH342Medicare UPIN
TXE53322Medicare UPIN
TXP25170Medicare UPIN