Basic Information
| Provider Information | |||||||||
| NPI: | 1215330501 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBUS URGENT CARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 926 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789342215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138936214 | ||||||||
| FaxNumber: | 7186402713 | ||||||||
| Practice Location | |||||||||
| Address1: | 926 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789342215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138934773 | ||||||||
| FaxNumber: | 8007085070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2014 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | RAUF | ||||||||
| AuthorizedOfficialFirstName: | ABDUR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7138936214 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QU0200X | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 347139301 | 05 | TX | MEDICAID |