Provider Demographics
NPI:1154576106
Name:URGENT CARE INC
Entity type:Organization
Organization Name:URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-864-0622
Mailing Address - Street 1:200 W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4517
Mailing Address - Country:US
Mailing Address - Phone:228-864-0622
Mailing Address - Fax:228-864-7958
Practice Address - Street 1:12207 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2955
Practice Address - Country:US
Practice Address - Phone:228-831-1140
Practice Address - Fax:228-831-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty