Provider Demographics
NPI:1902245343
Name:24 HOUR URGENT CARE OF THE DESERT
Entity Type:Organization
Organization Name:24 HOUR URGENT CARE OF THE DESERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:MUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-775-9500
Mailing Address - Street 1:31938 TEMECULA PKWY
Mailing Address - Street 2:SUITE # A337
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6810
Mailing Address - Country:US
Mailing Address - Phone:760-775-9500
Mailing Address - Fax:760-775-0956
Practice Address - Street 1:82013 DR CARREON BLVD
Practice Address - Street 2:SUITE #G
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4832
Practice Address - Country:US
Practice Address - Phone:760-775-9500
Practice Address - Fax:760-775-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPPLYINGMedicare PIN