Provider Demographics
NPI:1205203882
Name:BLACK ROCK MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:BLACK ROCK MEDICAL CARE, INC.
Other - Org Name:HENRY MAYO URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-200-2500
Mailing Address - Street 1:23929 MCBEAN PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4467
Mailing Address - Country:US
Mailing Address - Phone:661-200-2500
Mailing Address - Fax:661-200-2504
Practice Address - Street 1:23929 MCBEAN PKWY STE 102
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4467
Practice Address - Country:US
Practice Address - Phone:661-200-2500
Practice Address - Fax:661-200-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-30
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545129261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care