Provider Demographics
NPI:1194791715
Name:URGENT CARE CENTER OF FOLSOM
Entity type:Organization
Organization Name:URGENT CARE CENTER OF FOLSOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-984-8244
Mailing Address - Street 1:1600 CREEKSIDE DR
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3444
Mailing Address - Country:US
Mailing Address - Phone:916-984-8244
Mailing Address - Fax:916-984-8207
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:SUITE 1400
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-984-8244
Practice Address - Fax:916-984-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5568260001Medicare NSC
CAZZZ02045ZMedicare PIN