Provider Demographics
NPI:1972861011
Name:URGENT FAMILY CARE INC
Entity Type:Organization
Organization Name:URGENT FAMILY CARE INC
Other - Org Name:GOSPHA G CAMPBELL MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GOSPHA
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-890-9393
Mailing Address - Street 1:1850 S WATERMAN AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2877
Mailing Address - Country:US
Mailing Address - Phone:909-890-9393
Mailing Address - Fax:909-890-9394
Practice Address - Street 1:1850 S WATERMAN AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2877
Practice Address - Country:US
Practice Address - Phone:909-890-9393
Practice Address - Fax:909-890-9394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSPHA G CAMPBELL MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 42352261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306012935Medicare PIN
CA1215182803Medicare PIN