Provider Demographics
NPI:1821435157
Name:AIC URGENT CARE, PLLC
Entity Type:Organization
Organization Name:AIC URGENT CARE, PLLC
Other - Org Name:AFFINITY IMMEDIATE CARE-GALVESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR GENERALIST/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-886-8964
Mailing Address - Street 1:2808 61ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551
Mailing Address - Country:US
Mailing Address - Phone:281-886-8964
Mailing Address - Fax:281-605-1914
Practice Address - Street 1:2808 61ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551
Practice Address - Country:US
Practice Address - Phone:281-886-8964
Practice Address - Fax:281-605-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148236Medicare PIN