NPIMap

Organization Active NPI

SJ Medical Clinic/Urgent Care

  • Non-Pharmacy Dispensing Site
  • San Jacinto, CA
National Provider Identifier
1063552040
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
A60821 Issued in CA
Legal business name
SJ MEDICAL CLINIC/URGENT CARE
Practice address
1695 S San Jacinto Ave
A
San Jacinto, CA 92583
Phone
(951) 665-1100
NPI assigned
Feb 7, 2007
Organization subpart
Yes
Parent organization
MEDVANTX INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X A60821 CA Primary

Addresses

Primary practice location

1695 S San Jacinto Ave
A
San Jacinto, CA 92583

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Phone (858) 625-2990

Other names 1

  • SJ Medical Center - Urgent Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Apex Healthcare Med Ctr8 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1063552040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 S SAN JACINTO AVE",
            "address_2": "A",
            "city": "SAN JACINTO",
            "state": "CA",
            "postal_code": "92583",
            "telephone_number": "951-665-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SJ MEDICAL CLINIC/URGENT CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX INC",
        "enumeration_date": "2007-02-07",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A60821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SJ Medical Center - Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jacinto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.