Provider Demographics
NPI:1962788125
Name:AIC URGENT CARE. PLLC
Entity type:Organization
Organization Name:AIC URGENT CARE. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-886-8964
Mailing Address - Street 1:2600 FM 1764
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568
Mailing Address - Country:US
Mailing Address - Phone:281-886-8964
Mailing Address - Fax:409-440-8071
Practice Address - Street 1:2600 FM 1764
Practice Address - Street 2:SUITE 190
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568
Practice Address - Country:US
Practice Address - Phone:281-886-8964
Practice Address - Fax:409-440-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9314261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7005181Medicaid
TX126646Medicare UPIN