Provider Demographics
NPI:1497781678
Name:URGENT CARE MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:URGENT CARE MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALMADGE
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-248-8561
Mailing Address - Street 1:9150 JEWEL LAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5337
Mailing Address - Country:US
Mailing Address - Phone:907-248-8561
Mailing Address - Fax:907-248-8563
Practice Address - Street 1:9150 JEWEL LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5337
Practice Address - Country:US
Practice Address - Phone:907-248-8561
Practice Address - Fax:907-248-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK242636261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG6361Medicaid
AKK152417Medicare ID - Type Unspecified
AKMDG6361Medicaid