Provider Demographics
NPI:1659673606
Name:DIAMONDHEAD URGENT CARE
Entity Type:Organization
Organization Name:DIAMONDHEAD URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FAMILY NURSE PRACTITIONER,
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:337-344-4492
Mailing Address - Street 1:4402 E ALOHA DR
Mailing Address - Street 2:SUITE 16
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3349
Mailing Address - Country:US
Mailing Address - Phone:228-364-9001
Mailing Address - Fax:228-364-9004
Practice Address - Street 1:4402 E ALOHA DR
Practice Address - Street 2:SUITE 16
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3349
Practice Address - Country:US
Practice Address - Phone:228-364-9001
Practice Address - Fax:228-364-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care