| Organization Name: | PASCAGOULA URGENT CARE CENTER LLC |
| NPI Number: | 1073846770 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN SCOTT COOPER (OWNER) |
| Mailing Address: | 4305 Denny Ave Pascagoula |
| State: | MS US |
| Postal Code: | 395815509 |
| Phone Number: | 2287622044 |
| Fax Number: | |
| NPI Enumeration Date: | 09/12/2009 |
| NPI Last Update Date: | 09/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 13038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |