Provider Demographics
NPI:1568658870
Name:HIGH DESERT CLINIC URGENT AND OCCUPATIONAL CARE LLC
Entity type:Organization
Organization Name:HIGH DESERT CLINIC URGENT AND OCCUPATIONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-885-2231
Mailing Address - Street 1:PO BOX 17689
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-7689
Mailing Address - Country:US
Mailing Address - Phone:520-885-2231
Mailing Address - Fax:520-885-2471
Practice Address - Street 1:77 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-459-8915
Practice Address - Fax:520-458-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ278400Medicaid
AZ278400Medicaid
AZZ119216Medicare PIN