Provider Demographics
NPI:1932419223
Name:NORTHGATE URGENT CARE LLC
Entity Type:Organization
Organization Name:NORTHGATE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-551-3102
Mailing Address - Street 1:3605 NORTHGATE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6400
Mailing Address - Country:US
Mailing Address - Phone:812-949-5749
Mailing Address - Fax:812-949-5794
Practice Address - Street 1:3605 NORTHGATE CT STE 110
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6400
Practice Address - Country:US
Practice Address - Phone:812-949-5749
Practice Address - Fax:812-949-5794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCCUPATIONAL MEDICINE PHYSICIANS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30085261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center