Provider Demographics
NPI:1386768448
Name:CORWIN URGENT CARE CENTER
Entity type:Organization
Organization Name:CORWIN URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-946-2957
Mailing Address - Street 1:PO BOX 3800
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0074
Mailing Address - Country:US
Mailing Address - Phone:760-242-4000
Mailing Address - Fax:760-242-5250
Practice Address - Street 1:16070 TUSCOLA ROAD
Practice Address - Street 2:#101
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-4000
Practice Address - Fax:760-242-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0054490Medicaid
ZZZ05916ZMedicare PIN
DN3787Medicare PIN