Country Club Urgent Care Center LLC

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

PA03258 Issued in TX

Legal business name

COUNTRY CLUB URGENT CARE CENTER LLC

Practice address

8041 N Mesa St
Suite B-2
El Paso, TX 79932-1735

Phone

(915) 474-2454

NPI assigned

Sep 7, 2014

Organization subpart

No

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

Authorized official

Name

Tracy Short

Title

PA-C

Phone

(915) 474-2454

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

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

• Stephen H Horton, MD

  • Emergency Medicine Physician
  • El Paso, TX
  • NPI 1508826066
  Medicare reassignment NPD
• Gary D Kavonian, MD

  • Emergency Medicine Physician
  • El Paso, TX
  • NPI 1558321331
  Medicare reassignment NPD
• John Edward Short, PA-C

  • Physician Assistant
  • El Paso, TX
  • NPI 1700935277
  Medicare reassignment

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

{
    "created_epoch": "1410048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418342400000",
    "number": "1477954683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8041 N MESA ST",
            "address_2": "SUITE B-2",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799321735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8041 N MESA ST",
            "address_2": "SUITE B-2",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799321735",
            "telephone_number": "915-474-2454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB URGENT CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-07",
        "last_updated": "2014-12-12",
        "status": "A",
        "authorized_official_last_name": "SHORT",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "PA-C",
        "authorized_official_telephone_number": "915-474-2454"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "TX",
            "license": "PA03258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218658701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40379761",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00825875",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39472876",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randy D Cottrell, OT
• Sylvia A Coulehan, N.P
• Counseling of El Paso, PLLC
• Counseling Specialty Group
• Country Club Medical Center LLC
• Marygrace Estrella Courreges, ACNP-BC
• Courtney G. Brown, M.D., P.a.
• Cynthia Ardis Courtney, AUD., CCC-A
• Luz Maria Couttolenc
• Eduardo Covarrubias, M.D.

• Urgent Care Clinic/Center in El Paso, TX
• Providers in El Paso, TX by specialty
• Urgent Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.