Provider Demographics
NPI:1689874950
Name:CARONDELET MEDICAL GROUP URGENT CARE, INC
Entity Type:Organization
Organization Name:CARONDELET MEDICAL GROUP URGENT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-872-7244
Mailing Address - Street 1:PO BOX 5087
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85703-0087
Mailing Address - Country:US
Mailing Address - Phone:520-872-7013
Mailing Address - Fax:520-872-7969
Practice Address - Street 1:1704 W ANKLAM RD # 105
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2656
Practice Address - Country:US
Practice Address - Phone:520-617-4920
Practice Address - Fax:520-791-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care