Provider Demographics
NPI:1871044677
Name:MED 360 URGENT CARE, LLC
Entity Type:Organization
Organization Name:MED 360 URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FAROUK
Authorized Official - Middle Name:ANWARUL
Authorized Official - Last Name:RAQUIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-487-4535
Mailing Address - Street 1:1700 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4036
Mailing Address - Country:US
Mailing Address - Phone:205-412-5720
Mailing Address - Fax:205-487-8827
Practice Address - Street 1:1700 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4036
Practice Address - Country:US
Practice Address - Phone:205-512-1058
Practice Address - Fax:205-487-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
AL170018261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care