COUNTRY CLUB URGENT CARE CENTER LLC NPI 1477954683

NPI Information

COUNTRY CLUB URGENT CARE CENTER LLC is an urgent care clinic center in El Paso, TX. COUNTRY CLUB URGENT CARE CENTER LLC NPI is 1477954683. The provider is registered as an organization entity type.

The provider's business location address is:

8041 N MESA ST
SUITE B-2
EL PASO, TX
ZIP 79932-735
Phone: (915) 474-2454

The provider's authorized official is Tracy Short .
The authorized official title is Pa-c and has the following contact phone number (915) 474-2454.

The CLIA number assigned to this NPI record is 45D2087965 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/7/2014 and was last updated on 12/12/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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