Provider Demographics
NPI:1447123526
Name:S&T URGENT CARE MANAGEMENT
Entity type:Organization
Organization Name:S&T URGENT CARE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THANTERAPHONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-835-7355
Mailing Address - Street 1:2845 COCHRAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7905
Mailing Address - Country:US
Mailing Address - Phone:805-504-1904
Mailing Address - Fax:
Practice Address - Street 1:2845 COCHRAN ST STE B
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7905
Practice Address - Country:US
Practice Address - Phone:805-504-1904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty