Provider Demographics
NPI:1760993182
Name:CLASSIC URGENT CARE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CLASSIC URGENT CARE A MEDICAL CORPORATION
Other - Org Name:CLASSIC URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:IMUAGBONRIE
Authorized Official - Last Name:IDONI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:559-399-8940
Mailing Address - Street 1:622 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2423
Mailing Address - Country:US
Mailing Address - Phone:559-399-8940
Mailing Address - Fax:559-399-8657
Practice Address - Street 1:622 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2423
Practice Address - Country:US
Practice Address - Phone:559-399-8940
Practice Address - Fax:559-399-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care