Provider Demographics
NPI:1356789366
Name:URGENT CARE MEDICAL CLINIC, PC
Entity type:Organization
Organization Name:URGENT CARE MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-770-2380
Mailing Address - Street 1:9150 JEWEL LAKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5381
Mailing Address - Country:US
Mailing Address - Phone:907-248-8561
Mailing Address - Fax:907-248-8563
Practice Address - Street 1:5437 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4712
Practice Address - Country:US
Practice Address - Phone:907-333-8561
Practice Address - Fax:907-333-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK242636261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center