Provider Demographics
NPI:1396041695
Name:PARTNERS URGENT CARE-GROSSMONT
Entity Type:Organization
Organization Name:PARTNERS URGENT CARE-GROSSMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:AMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-389-5700
Mailing Address - Street 1:18231 IRVINE BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3432
Mailing Address - Country:US
Mailing Address - Phone:714-389-5700
Mailing Address - Fax:
Practice Address - Street 1:6136 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2502
Practice Address - Country:US
Practice Address - Phone:714-389-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34265261QE0002X, 261QU0200X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine