Provider Demographics
NPI:1497186985
Name:TABORIAN URGENT CARE CENTER PROJECT INC.
Entity Type:Organization
Organization Name:TABORIAN URGENT CARE CENTER PROJECT INC.
Other - Org Name:TABORIAN URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-741-3222
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762-0073
Mailing Address - Country:US
Mailing Address - Phone:662-741-3222
Mailing Address - Fax:662-741-3022
Practice Address - Street 1:101 N. EDWARDS AVENUE
Practice Address - Street 2:
Practice Address - City:MOUND BAYOU
Practice Address - State:MS
Practice Address - Zip Code:38762-9594
Practice Address - Country:US
Practice Address - Phone:662-741-3222
Practice Address - Fax:662-741-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care