Classic Urgent Care a Medical Corporation
Organization Active NPI Urgent Care Clinic/Center · Sanger, CA
NPI 1760993182 · NPPES record last updated Oct 12, 2017
Key facts
- NPI
- 1760993182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urgent Care Clinic/Center 261QU0200X
- Legal business name
- CLASSIC URGENT CARE A MEDICAL CORPORATION
- Practice address
- 622 Academy Ave
Sanger, CA 93657-2423 - Phone
- (559) 399-8940
- Fax
- (559) 399-8657
- NPI assigned
- Oct 12, 2017
- Organization subpart
- No
Authorized official
- Name
- Joseph Imuagbonrie Idoni, PA
- Title
- Ceo
- Phone
- (559) 399-8940
Practitioners 2
-
Raynado Garcia, M.D.
-
Joseph I Idoni, MPH, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2131452 | Classic Urgent Care | Certificate of waiver | May 29, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180319002755 | CA | Part B Supplier - Clinic/Group Practice | 9931461530 |
Receives reassigned benefits from 2 practitioners Practice locations: Sanger, CA |
National Provider Directory
Locations
622 Academy Ave
Sanger, CA 93657
Phone (559) 399-8940
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | Yes |
Addresses
Primary practice location
622 Academy Ave
Sanger, CA 93657-2423
Mailing address
622 Academy Ave
Sanger, CA 93657-2423
Phone (559) 399-8940
Other names
- Classic Urgent Care
Other providers in Sanger, CA
- Donna Lee Chastain
- Maria Esmeralda Chavez
- Paul Sylvan Cheney
- Ishwaree Rajiv Chogle
- City of Sanger Fire Department
- Herbert Lance Crooks
- Daniel Cuellar
- Tram Ngoc Dang
- David Trieu Nguyen
- Ignacio N De Alba Ruiz
All providers in Sanger, CA · Urgent Care Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.