Provider Demographics
NPI:1346558566
Name:DESOTO URGENT CARE CLINIC, LLC
Entity Type:Organization
Organization Name:DESOTO URGENT CARE CLINIC, LLC
Other - Org Name:DESOTO PHYSICIANS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ULRIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-280-8222
Mailing Address - Street 1:9215 MILLBRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1423
Mailing Address - Country:US
Mailing Address - Phone:662-280-8222
Mailing Address - Fax:662-280-5541
Practice Address - Street 1:9215 MILLBRANCH RD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1423
Practice Address - Country:US
Practice Address - Phone:662-280-8222
Practice Address - Fax:662-280-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care