Provider Demographics
NPI:1477707701
Name:LATHROP URGENT CARE, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LATHROP URGENT CARE, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANSLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-814-7262
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-0829
Mailing Address - Country:US
Mailing Address - Phone:209-983-9000
Mailing Address - Fax:209-983-9001
Practice Address - Street 1:15810 S HARLAN RD STE A
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8719
Practice Address - Country:US
Practice Address - Phone:209-983-9000
Practice Address - Fax:209-983-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care