Provider Demographics
NPI:1255877650
Name:NEWMD URGENT CARE CENTER, INC.
Entity type:Organization
Organization Name:NEWMD URGENT CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-731-1108
Mailing Address - Street 1:3431 BROADWAY ST
Mailing Address - Street 2:A8
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1228
Mailing Address - Country:US
Mailing Address - Phone:707-731-1108
Mailing Address - Fax:707-652-2679
Practice Address - Street 1:10612 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2620
Practice Address - Country:US
Practice Address - Phone:510-529-4628
Practice Address - Fax:707-652-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA217552Medicare PIN
CACA106244Medicare PIN