Provider Demographics
NPI:1306855119
Name:WILLOW URGENT CARE, A SUBSIDIARY OF MEMORIAL HEALTHCARE IPA
Entity Type:Organization
Organization Name:WILLOW URGENT CARE, A SUBSIDIARY OF MEMORIAL HEALTHCARE IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-981-9500
Mailing Address - Street 1:2704 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2217
Mailing Address - Country:US
Mailing Address - Phone:562-981-9500
Mailing Address - Fax:562-981-9521
Practice Address - Street 1:2704 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2217
Practice Address - Country:US
Practice Address - Phone:562-981-9500
Practice Address - Fax:562-981-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17181Medicare UPIN