Provider Demographics
NPI:1316976251
Name:ANGLETON URGENT CARE LLC
Entity type:Organization
Organization Name:ANGLETON URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:832-551-9945
Mailing Address - Street 1:2315 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3804
Mailing Address - Country:US
Mailing Address - Phone:979-849-1747
Mailing Address - Fax:979-848-8563
Practice Address - Street 1:2315 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3804
Practice Address - Country:US
Practice Address - Phone:979-849-1747
Practice Address - Fax:979-848-8563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGLETON URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179092501Medicaid
TX0025MFOtherBCBS #
TX179092501Medicaid