Provider Demographics
NPI:1760403125
Name:NORCAL URGENT CARE, INC
Entity Type:Organization
Organization Name:NORCAL URGENT CARE, INC
Other - Org Name:MAIN STREET URGENT CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANSLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-825-5155
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-0969
Mailing Address - Country:US
Mailing Address - Phone:209-825-5155
Mailing Address - Fax:209-825-6155
Practice Address - Street 1:1040 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3745
Practice Address - Country:US
Practice Address - Phone:209-825-5155
Practice Address - Fax:209-825-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54317261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1045635OtherCLIA
CAGR0100060Medicaid
CAGR0100060Medicaid