Provider Demographics
NPI:1730957879
Name:COOPER STREET URGENT CARE LLC
Entity type:Organization
Organization Name:COOPER STREET URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-257-3500
Mailing Address - Street 1:PO BOX 941805
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-1805
Mailing Address - Country:US
Mailing Address - Phone:469-482-0861
Mailing Address - Fax:469-273-1720
Practice Address - Street 1:6407 S COOPER ST STE 117
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5813
Practice Address - Country:US
Practice Address - Phone:469-482-0861
Practice Address - Fax:469-273-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care