Provider Demographics
NPI:1578613188
Name:URGENT MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:URGENT MEDICAL CLINIC INC
Other - Org Name:PRIME URGENT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-536-1020
Mailing Address - Street 1:176 GOODMAN RD W
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9405
Mailing Address - Country:US
Mailing Address - Phone:662-536-1020
Mailing Address - Fax:
Practice Address - Street 1:176 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9405
Practice Address - Country:US
Practice Address - Phone:662-536-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15476207Q00000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty