Provider Demographics
NPI:1629303383
Name:ORLAND URGENT CARE INC., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ORLAND URGENT CARE INC., PROFESSIONAL CORPORATION
Other - Org Name:ROSS W TYE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:W
Authorized Official - Last Name:TYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-865-3400
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-4102
Mailing Address - Country:US
Mailing Address - Phone:530-865-3400
Mailing Address - Fax:530-865-3386
Practice Address - Street 1:1361 CORTINA DR
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-2402
Practice Address - Country:US
Practice Address - Phone:530-865-3400
Practice Address - Fax:530-865-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM553840FMedicaid
CABF583BMedicare PIN
CAA28374Medicare UPIN
CARHM553840FMedicaid