Provider Demographics
NPI:1215939814
Name:BACLIFF URGENT CARE, INC
Entity type:Organization
Organization Name:BACLIFF URGENT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:281-222-3951
Mailing Address - Street 1:2826 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5750
Mailing Address - Country:US
Mailing Address - Phone:281-334-6328
Mailing Address - Fax:281-538-1715
Practice Address - Street 1:1136 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BACLIFF
Practice Address - State:TX
Practice Address - Zip Code:77518-2760
Practice Address - Country:US
Practice Address - Phone:281-339-5018
Practice Address - Fax:281-339-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00742OtherLICENSE