Provider Demographics
NPI:1669654968
Name:MY URBAN CLINIC
Entity Type:Organization
Organization Name:MY URBAN CLINIC
Other - Org Name:MY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-278-8710
Mailing Address - Street 1:PO BOX 421472
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77242-1472
Mailing Address - Country:US
Mailing Address - Phone:713-278-8710
Mailing Address - Fax:713-278-1910
Practice Address - Street 1:305 N JUDD PKWY NE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2370
Practice Address - Country:US
Practice Address - Phone:713-278-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center