Provider Demographics
NPI:1477585925
Name:STOCKTON URGENT CARE MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:STOCKTON URGENT CARE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BIRLEW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-952-9696
Mailing Address - Street 1:1148 W HAMMER LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-3011
Mailing Address - Country:US
Mailing Address - Phone:209-952-9696
Mailing Address - Fax:209-952-3414
Practice Address - Street 1:1148 W HAMMER LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-3011
Practice Address - Country:US
Practice Address - Phone:209-952-9696
Practice Address - Fax:209-952-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty