Provider Demographics
NPI:1225380868
Name:ST. MARY'S URGENT CARE
Entity Type:Organization
Organization Name:ST. MARY'S URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAGUINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-474-1500
Mailing Address - Street 1:2333 W MARCH LN STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5272
Mailing Address - Country:US
Mailing Address - Phone:209-474-1500
Mailing Address - Fax:209-762-1732
Practice Address - Street 1:2333 W MARCH LN STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5272
Practice Address - Country:US
Practice Address - Phone:209-474-1500
Practice Address - Fax:209-762-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054317261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service