Provider Demographics
NPI:1861789083
Name:DOWNRIVER URGENT CARE PLLC
Entity type:Organization
Organization Name:DOWNRIVER URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-JARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-282-5444
Mailing Address - Street 1:15830 FORT ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1367
Mailing Address - Country:US
Mailing Address - Phone:734-282-5444
Mailing Address - Fax:734-282-4899
Practice Address - Street 1:15830 FORT ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1367
Practice Address - Country:US
Practice Address - Phone:734-282-5444
Practice Address - Fax:734-282-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057471261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4627560Medicaid
MI4627506Medicaid
MIG40626Medicare UPIN
MI0N9427002Medicare PIN
MI4627560Medicaid
MI4627506Medicaid