Provider Demographics
NPI:1467120535
Name:MED 360 URGENT CARE WINFIELD LLC
Entity Type:Organization
Organization Name:MED 360 URGENT CARE WINFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAROUK
Authorized Official - Middle Name:ANWARUL
Authorized Official - Last Name:RAQUIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-487-4535
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-1140
Mailing Address - Country:US
Mailing Address - Phone:205-487-4535
Mailing Address - Fax:205-487-8875
Practice Address - Street 1:125 BOB LAWRENCE DRIVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594
Practice Address - Country:US
Practice Address - Phone:205-487-4535
Practice Address - Fax:205-487-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00032921Medicaid