Basic Information
| Provider Information | |||||||||
| NPI: | 1770968919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUCH URGENT CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 RIDGEVIEW CV | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388010400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628406824 | ||||||||
| FaxNumber: | 6014205299 | ||||||||
| Practice Location | |||||||||
| Address1: | 1710 N GLOSTER ST | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388041216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628406824 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | MCCOY | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6628406824 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 09229002 | 05 | MS | MEDICAID |