Provider Demographics
NPI:1831204759
Name:PHYSICIANS URGENT CARE CENTER, INC.
Entity type:Organization
Organization Name:PHYSICIANS URGENT CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-762-1911
Mailing Address - Street 1:1201 E. HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2018
Mailing Address - Country:US
Mailing Address - Phone:580-762-1911
Mailing Address - Fax:580-762-0887
Practice Address - Street 1:1201 E. HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2018
Practice Address - Country:US
Practice Address - Phone:580-762-1911
Practice Address - Fax:580-762-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100707120CMedicaid
OK100707120BMedicaid
OKCK2751OtherRAILROAD MEDICARE
OK100707120CMedicaid