Provider Demographics
NPI:1598550840
Name:URGENT CARE CLINIC INC
Entity type:Organization
Organization Name:URGENT CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOLLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACWAN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:847-881-7863
Mailing Address - Street 1:1815 AUTUMN DR APT 310
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1180
Mailing Address - Country:US
Mailing Address - Phone:847-323-4491
Mailing Address - Fax:
Practice Address - Street 1:1815 AUTUMN DR APT 310
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1180
Practice Address - Country:US
Practice Address - Phone:847-323-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)