Provider Demographics
NPI:1750644258
Name:JURKOWSKI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JURKOWSKI MEDICAL CORPORATION
Other - Org Name:MD TODAY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JURKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-622-0554
Mailing Address - Street 1:10605 SCRIPPS POWAY PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3925
Mailing Address - Country:US
Mailing Address - Phone:858-622-0554
Mailing Address - Fax:858-622-1417
Practice Address - Street 1:10605 SCRIPPS POWAY PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3925
Practice Address - Country:US
Practice Address - Phone:858-622-0554
Practice Address - Fax:858-622-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43217207Q00000X, 208D00000X
CA1750644258261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGK976AOtherGROUP MEDICARE PTAN
CAC43217Medicare PIN
CAG05006Medicare UPIN