Provider Demographics
NPI:1730367152
Name:URGENT CARE CLINIC PLC
Entity type:Organization
Organization Name:URGENT CARE CLINIC PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-273-5154
Mailing Address - Street 1:1850 PIPESTONE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-2304
Mailing Address - Country:US
Mailing Address - Phone:269-925-6600
Mailing Address - Fax:269-925-9528
Practice Address - Street 1:1850 PIPESTONE RD
Practice Address - Street 2:STE 101
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2304
Practice Address - Country:US
Practice Address - Phone:269-925-6600
Practice Address - Fax:269-925-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILM037695261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI217649700OtherUSPS
MILM037695OtherLICENSE
MI020A110440OtherBCBSM
MILM037695OtherLICENSE
MILM037695OtherLICENSE