Basic Information
| Provider Information | |||||||||
| NPI: | 1538565049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UCXTRA UMBRELLA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | URGENT CARE EXTRA AZ | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 S CLEARVIEW AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852093378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809889108 | ||||||||
| FaxNumber: | 4808134460 | ||||||||
| Practice Location | |||||||||
| Address1: | 6702 W BETHANY HOME RD | ||||||||
| Address2: | SUITE 13, 14 & 15 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853034402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234357000 | ||||||||
| FaxNumber: | 6234353947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2014 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | PANDURO | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4806632432 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 1518952365 | AZ | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.