NPIMap

Organization Active NPI

Broad Avenue Urgent Care

  • Urgent Care Clinic/Center
  • Gulfport, MS
National Provider Identifier
1164727285
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
BROAD AVENUE URGENT CARE
Practice address
1104 Broad Ave
Suite B
Gulfport, MS 39501-2414
Phone
(228) 314-1340
Fax
(228) 314-1342
NPI assigned
Jan 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Authorized official

Name
Ronnie Ali, D.O.
Title
Owner
Phone
(228) 314-1340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1104 Broad Ave
Suite B
Gulfport, MS 39501-2414

Mailing address

PO Box 1248
Ocean Springs, MS 39566-1248
Phone (228) 314-1340

National Provider Directory

National Provider Directory

Locations

1104 Broad Ave
#B
Gulfport, MS 39501
Phone (228) 314-1340

1104 Broad Ave
Ste B
Gulfport, MS 39501
Phone (228) 314-1340

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1164727285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1248",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395661248",
            "telephone_number": "228-314-1340",
            "fax_number": "228-314-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 BROAD AVE",
            "address_2": "SUITE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012414",
            "telephone_number": "228-314-1340",
            "fax_number": "228-314-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD AVENUE URGENT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-20",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "RONNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-314-1340",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.