Provider Demographics
NPI:1265453872
Name:TRACY URGENT CARE, INC
Entity Type:Organization
Organization Name:TRACY URGENT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-832-8700
Mailing Address - Street 1:2160 W GRANT LINE RD STE 230
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7334
Mailing Address - Country:US
Mailing Address - Phone:209-832-8700
Mailing Address - Fax:209-832-2210
Practice Address - Street 1:2160 W GRANT LINE RD
Practice Address - Street 2:STE.230
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7330
Practice Address - Country:US
Practice Address - Phone:209-832-8700
Practice Address - Fax:209-832-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089170Medicaid
CAZZZ20127ZMedicare ID - Type Unspecified