Provider Demographics
NPI:1235442872
Name:PASCAGOULA URGENT CARE
Entity Type:Organization
Organization Name:PASCAGOULA URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:228-372-6040
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-1248
Mailing Address - Country:US
Mailing Address - Phone:228-372-6040
Mailing Address - Fax:228-372-6043
Practice Address - Street 1:2210 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-3416
Practice Address - Country:US
Practice Address - Phone:228-372-6040
Practice Address - Fax:228-372-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04209759Medicaid
MS302G707887Medicare PIN