Provider Demographics
NPI:1619244670
Name:CARE 1ST PRIMARY AND URGENT CARE CENTER - LANCASTER
Entity Type:Organization
Organization Name:CARE 1ST PRIMARY AND URGENT CARE CENTER - LANCASTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-948-2400
Mailing Address - Street 1:44426 10TH ST W
Mailing Address - Street 2:A
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3325
Mailing Address - Country:US
Mailing Address - Phone:661-948-2400
Mailing Address - Fax:
Practice Address - Street 1:44426 10TH ST W
Practice Address - Street 2:A
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3325
Practice Address - Country:US
Practice Address - Phone:661-948-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE1ST HEALTH PLAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X, 261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty