Provider Demographics
NPI:1902827702
Name:MED-7 URGENT CARE CENTER MEDICAL GROUP
Entity Type:Organization
Organization Name:MED-7 URGENT CARE CENTER MEDICAL GROUP
Other - Org Name:MED7 URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-791-1300
Mailing Address - Street 1:PO BOX 619115
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-9115
Mailing Address - Country:US
Mailing Address - Phone:916-791-1300
Mailing Address - Fax:916-483-3790
Practice Address - Street 1:701 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4502
Practice Address - Country:US
Practice Address - Phone:916-772-6337
Practice Address - Fax:916-772-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28497ZMedicare PIN
CAZZZ16566ZMedicare PIN