Provider Demographics
NPI:1932587706
Name:STATE URGENT CARE, LLC
Entity Type:Organization
Organization Name:STATE URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENNAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:UTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-706-3033
Mailing Address - Street 1:521 S MONTGOMERY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3337
Mailing Address - Country:US
Mailing Address - Phone:662-338-4826
Mailing Address - Fax:662-268-8052
Practice Address - Street 1:521 S MONTGOMERY ST STE 1
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3337
Practice Address - Country:US
Practice Address - Phone:662-338-4826
Practice Address - Fax:662-268-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care