1689959702 NPI number — MIDMICHIGAN URGENT CARE FREELAND

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689959702 NPI number — MIDMICHIGAN URGENT CARE FREELAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDMICHIGAN URGENT CARE FREELAND
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:
1689959702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5694 MIDLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREELAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48623-8845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-695-4999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2618 W SUGNET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48640-2647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-633-5237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DRIMALLA
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
989-633-1350

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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