1790030385 NPI number — HOMETOWN URGENT CARE OF MICHIGAN, P.C.

Table of content: (NPI 1790030385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790030385 NPI number — HOMETOWN URGENT CARE OF MICHIGAN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMETOWN URGENT CARE OF MICHIGAN, 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:
WELLNOW URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1790030385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTTVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14731-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-699-9032
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6210 BRANDT PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUBER HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45424-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-236-8630
Provider Business Practice Location Address Fax Number:
937-236-8635
Provider Enumeration Date:
07/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RADFORD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-699-9032

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1790030385 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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