Provider Demographics
NPI:1144632076
Name:FAMILY URGENT CARE
Entity type:Organization
Organization Name:FAMILY URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:TAREQ
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-339-3797
Mailing Address - Street 1:1520 W KETTLEMAN LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-9290
Mailing Address - Country:US
Mailing Address - Phone:209-339-3797
Mailing Address - Fax:209-339-3795
Practice Address - Street 1:1520 W KETTLEMAN LN
Practice Address - Street 2:SUITE B
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9290
Practice Address - Country:US
Practice Address - Phone:209-339-3797
Practice Address - Fax:209-339-3795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAREQ A ALI MD APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-27
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51048261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN602AMedicare PIN
CAF49243Medicare UPIN