Provider Demographics
NPI:1265172266
Name:AE URGENT CARE - VAN NUYS
Entity type:Organization
Organization Name:AE URGENT CARE - VAN NUYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCHUYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-264-1212
Mailing Address - Street 1:14614 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1621
Mailing Address - Country:US
Mailing Address - Phone:747-264-1212
Mailing Address - Fax:
Practice Address - Street 1:14614 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1621
Practice Address - Country:US
Practice Address - Phone:747-264-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003053851OtherLA CARE