Provider Demographics
NPI:1801181961
Name:EXECUTIVE URGENT CARE OF INDIAN WELLS
Entity Type:Organization
Organization Name:EXECUTIVE URGENT CARE OF INDIAN WELLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:TANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-346-3932
Mailing Address - Street 1:74785 HIGHWAY 111
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210
Mailing Address - Country:US
Mailing Address - Phone:760-346-3932
Mailing Address - Fax:760-346-8584
Practice Address - Street 1:74785 HIGHWAY 111
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210
Practice Address - Country:US
Practice Address - Phone:760-346-3932
Practice Address - Fax:760-346-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44271261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care