Provider Demographics
NPI:1922461094
Name:NORMANDY URGENT CARE CENTER PA
Entity Type:Organization
Organization Name:NORMANDY URGENT CARE CENTER PA
Other - Org Name:IMPERIAL VALLEY URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-405-9600
Mailing Address - Street 1:16272 IMPERIAL VALLEY DR
Mailing Address - Street 2:SUITE K,
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3529
Mailing Address - Country:US
Mailing Address - Phone:281-405-9600
Mailing Address - Fax:281-405-9605
Practice Address - Street 1:16272 IMPERIAL VALLEY DR
Practice Address - Street 2:SUITE K,
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3529
Practice Address - Country:US
Practice Address - Phone:281-405-9600
Practice Address - Fax:281-405-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281208301Medicaid
TX281208301Medicaid