Provider Demographics
NPI:1952752396
Name:INTERSTATE URGENT CARE MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:INTERSTATE URGENT CARE MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-921-6309
Mailing Address - Street 1:18300 GRIDLEY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5401
Mailing Address - Country:US
Mailing Address - Phone:562-332-6003
Mailing Address - Fax:623-326-1285
Practice Address - Street 1:18300 GRIDLEY RD STE 301
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5401
Practice Address - Country:US
Practice Address - Phone:562-332-6003
Practice Address - Fax:623-326-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty