Provider Demographics
NPI:1073238747
Name:MED 360 URGENT CARE NORTHPORT LLC
Entity type:Organization
Organization Name:MED 360 URGENT CARE NORTHPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FAROUK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAQUIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-326-3875
Mailing Address - Street 1:3250 MCFARLAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3135
Mailing Address - Country:US
Mailing Address - Phone:205-632-3875
Mailing Address - Fax:205-462-3056
Practice Address - Street 1:3250 MCFARLAND BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3135
Practice Address - Country:US
Practice Address - Phone:205-487-4535
Practice Address - Fax:205-487-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL322964Medicaid
AL512-92816OtherBCBS
AL1477511194OtherNPI
AL315872Medicaid