Provider Demographics
NPI:1235633793
Name:GOLD CROSS URGENT CARE, LLC
Entity Type:Organization
Organization Name:GOLD CROSS URGENT CARE, LLC
Other - Org Name:GOLD CROSS FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EZINNE
Authorized Official - Middle Name:CHARITY
Authorized Official - Last Name:NWUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-862-2331
Mailing Address - Street 1:500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71749-9597
Mailing Address - Country:US
Mailing Address - Phone:870-862-2331
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:AR
Practice Address - Zip Code:71749-9597
Practice Address - Country:US
Practice Address - Phone:870-862-2331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty