Provider Demographics
NPI:1427432244
Name:IMA URGENT CARE
Entity type:Organization
Organization Name:IMA URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-460-9840
Mailing Address - Street 1:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:1026 BROAD ST UNIT 18
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4380
Practice Address - Country:US
Practice Address - Phone:732-460-9840
Practice Address - Fax:732-460-9848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED MEDICINE ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-10
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QU0200X261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3259501Medicaid
NJCA1204OtherMEDICARE RAILROAD
NJJ020393OtherCHAMPUS
NJJ020393OtherCHAMPUS