Provider Demographics
NPI:1831510510
Name:1488 URGENT CARE CLINIC, LLC
Entity type:Organization
Organization Name:1488 URGENT CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUDHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-785-1119
Mailing Address - Street 1:3600 FM 1488 RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 FM 1488 RD
Practice Address - Street 2:STE. 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3817
Practice Address - Country:US
Practice Address - Phone:718-480-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URGENT CLINICS MEDICAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-23
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care