Provider Demographics
NPI:1407104987
Name:CALIFORNIA URGENT CARE PROVIDER NETWORK, LLC
Entity Type:Organization
Organization Name:CALIFORNIA URGENT CARE PROVIDER NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-734-7717
Mailing Address - Street 1:7332 E BUTHERUS DR
Mailing Address - Street 2:HANGAR ONE
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2426
Mailing Address - Country:US
Mailing Address - Phone:480-734-7717
Mailing Address - Fax:
Practice Address - Street 1:7332 E BUTHERUS DR
Practice Address - Street 2:HANGAR ONE
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2426
Practice Address - Country:US
Practice Address - Phone:480-734-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care