Provider Demographics
NPI:1407882608
Name:INLAND URGENT CARE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:INLAND URGENT CARE A MEDICAL CORPORATION
Other - Org Name:INLAND URGENT CARE WILDOMAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-471-3888
Mailing Address - Street 1:31588 RAILROAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9468
Mailing Address - Country:US
Mailing Address - Phone:951-471-3888
Mailing Address - Fax:951-471-2965
Practice Address - Street 1:36320 INLAND VALLEY DR STE 307
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7512
Practice Address - Country:US
Practice Address - Phone:951-600-0110
Practice Address - Fax:951-600-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07513ZOtherBLUE SHIELD GROUP NUMBER
CAA45504OtherLICENSE
CAA78505OtherLICENSE
CAA78505OtherLICENSE
CAZZZ23544ZMedicare ID - Type UnspecifiedGROUP NUMBER