Provider Demographics
NPI:1275716110
Name:URBAN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:URBAN HEALTHCARE, LLC
Other - Org Name:SANTA CLARA FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:URTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-923-2273
Mailing Address - Street 1:2837 CLINTON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-8401
Mailing Address - Country:US
Mailing Address - Phone:713-923-2273
Mailing Address - Fax:713-923-2276
Practice Address - Street 1:5616 LAWNDALE ST
Practice Address - Street 2:SUITE A-203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3840
Practice Address - Country:US
Practice Address - Phone:713-923-2273
Practice Address - Fax:713-923-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192241102Medicaid
TX0011RBOtherBCBS
TX192241101Medicaid
TX192241102Medicaid