Provider Demographics
NPI:1417280884
Name:UNIVERSITY CITY URGENT CARE CLINIC INC
Entity Type:Organization
Organization Name:UNIVERSITY CITY URGENT CARE CLINIC INC
Other - Org Name:STARKVILLE URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-9760
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:1201 STARK ROAD
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-0845
Mailing Address - Country:US
Mailing Address - Phone:662-324-9760
Mailing Address - Fax:662-324-9761
Practice Address - Street 1:1201 STARK ROAD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39760
Practice Address - Country:US
Practice Address - Phone:662-324-9760
Practice Address - Fax:662-324-9761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05731806Medicaid