Provider Demographics
NPI:1942743968
Name:OC URGENTCARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:OC URGENTCARE MEDICAL GROUP, INC
Other - Org Name:OC URGENTCARE SANTA ANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAHLA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-991-5700
Mailing Address - Street 1:PO BOX 2638
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0638
Mailing Address - Country:US
Mailing Address - Phone:714-991-5700
Mailing Address - Fax:714-991-5800
Practice Address - Street 1:2001 E 4TH ST
Practice Address - Street 2:104
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3916
Practice Address - Country:US
Practice Address - Phone:657-230-7800
Practice Address - Fax:657-230-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106233261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB088AMedicare PIN