Provider Demographics
NPI:1922289099
Name:MERIDIAN URGENT CARE & OCCUPATIONAL HEALTH CENTER A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:MERIDIAN URGENT CARE & OCCUPATIONAL HEALTH CENTER A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASILE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-242-7707
Mailing Address - Street 1:18522 HIGHWAY 18
Mailing Address - Street 2:SUITE 102
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-7707
Mailing Address - Fax:
Practice Address - Street 1:18522 HIGHWAY 18
Practice Address - Street 2:SUITE 102
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6930261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA660070Medicare UPIN