Provider Demographics
NPI:1417605700
Name:MARQUE MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:MARQUE MEDICAL CLINIC, INC
Other - Org Name:MARQUE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RCM
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-529-8714
Mailing Address - Street 1:2075 SAN JOAQUIN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6505
Mailing Address - Country:US
Mailing Address - Phone:714-707-6499
Mailing Address - Fax:949-629-3509
Practice Address - Street 1:21771 LAKE FOREST DR STE 109
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2782
Practice Address - Country:US
Practice Address - Phone:714-707-6499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARQUE MEDICAL CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-15
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care