Provider Demographics
NPI:1689067472
Name:MYDOC URGENT CARE
Entity Type:Organization
Organization Name:MYDOC URGENT CARE
Other - Org Name:MYDOC HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JINGJING
Authorized Official - Middle Name:
Authorized Official - Last Name:CAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-350-3956
Mailing Address - Street 1:3135 ALPIN DR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1634
Mailing Address - Country:US
Mailing Address - Phone:215-350-3956
Mailing Address - Fax:
Practice Address - Street 1:1420 LOCUST ST UNIT R1A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4223
Practice Address - Country:US
Practice Address - Phone:215-350-3956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine