Provider Demographics
NPI:1407352453
Name:ONLINE URGENT CARE, INC.
Entity Type:Organization
Organization Name:ONLINE URGENT CARE, INC.
Other - Org Name:PRAIRIE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-422-3444
Mailing Address - Street 1:10390 WILSHIRE BLVD APT 1410
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6424
Mailing Address - Country:US
Mailing Address - Phone:310-422-3444
Mailing Address - Fax:
Practice Address - Street 1:14921 PRAIRIE AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1849
Practice Address - Country:US
Practice Address - Phone:310-422-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty