Provider Demographics
NPI:1871920454
Name:TUSCAN 96 URGENT CARE CLINIC LLC
Entity type:Organization
Organization Name:TUSCAN 96 URGENT CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUDHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-785-1119
Mailing Address - Street 1:2560 STATE HIGHWAY 96
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-0000
Mailing Address - Country:US
Mailing Address - Phone:718-480-1980
Mailing Address - Fax:
Practice Address - Street 1:2560 STATE HIGHWAY 96
Practice Address - Street 2:SUITE B
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:718-480-1980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty