Provider Demographics
NPI:1598100885
Name:1960 URGENT CARE, LLC
Entity Type:Organization
Organization Name:1960 URGENT CARE, LLC
Other - Org Name:LIVEWELL URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-689-8091
Mailing Address - Street 1:5361 FAIRDALE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6630
Mailing Address - Country:US
Mailing Address - Phone:713-689-8091
Mailing Address - Fax:866-321-1602
Practice Address - Street 1:6930 FM 1960 WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-0000
Practice Address - Country:US
Practice Address - Phone:713-689-8091
Practice Address - Fax:866-321-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3906261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care