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Organization

COUNTRY CLUB URGENT CARE CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRACY SHORT (PA-C)
(915) 474-2454
Entity
Organization

Contact information

Practice address
8041 N MESA ST, SUITE B-2, EL PASO, TX 79932-1735
(915) 474-2454
Mailing address
8041 N MESA ST, SUITE B-2, EL PASO, TX 79932-1735

Taxonomy

Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
PA03258
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00825875
NM
05
218658701
TX
05
39472876
NM
05
40379761
NM
Enumeration date
09/07/2014
Last updated
12/12/2014
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