1316018971 NPI number — ROCHESTER URGENT CARE, P.C.

Table of content: (NPI 1316018971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316018971 NPI number — ROCHESTER URGENT CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCHESTER URGENT CARE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316018971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 E AUBURN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-5260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-853-2009
Provider Business Mailing Address Fax Number:
248-853-4105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 E AUBURN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-5260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-853-2009
Provider Business Practice Location Address Fax Number:
248-853-4105
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAGE
Authorized Official First Name:
TABATHA
Authorized Official Middle Name:
LEANNE
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
248-853-2009

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235377052 . This is a "BLUE CARE NETWORK OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OM27740 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700F313160 . This is a "BCBS NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1316018971 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1316018971 . This is a "COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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