Provider Demographics
NPI:1942245675
Name:MEDICAL URGENT CARE, LLC
Entity Type:Organization
Organization Name:MEDICAL URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIJAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-661-0555
Mailing Address - Street 1:3158 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6449
Mailing Address - Country:US
Mailing Address - Phone:513-661-0555
Mailing Address - Fax:513-661-2860
Practice Address - Street 1:3158 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6449
Practice Address - Country:US
Practice Address - Phone:513-661-0555
Practice Address - Fax:513-661-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081770261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000383589OtherANTHEM
OH2607914Medicaid
OH2607914Medicaid
OH=========00OtherWORKER COMPENSATION
OH9357781Medicare PIN