Provider Demographics
NPI:1497806418
Name:SUPERIOR WALK-IN CENTER, PC
Entity type:Organization
Organization Name:SUPERIOR WALK-IN CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-387-4220
Mailing Address - Street 1:1504 SAND POINT RD
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1406
Mailing Address - Country:US
Mailing Address - Phone:906-387-4220
Mailing Address - Fax:906-387-5449
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 134
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-226-2233
Practice Address - Fax:906-226-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080Z210080OtherBLUE CROSS GROUP
MI0800217321OtherBLUE CROSS OF MI
MI3114604Medicaid
MI135602000OtherUS DEPT OF LABOR
MI23D961305OtherCLIA
MI135602000OtherUNITED STATES POST OFFICE
MI080Z210080OtherBLUE CROSS GROUP
MI3114604Medicaid
MI135602000OtherUNITED STATES POST OFFICE