1831435924 NPI number — PEREGRINE URGENT CARE INC.

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 1831435924 NPI number — PEREGRINE URGENT CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEREGRINE URGENT CARE INC.
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:
DOCTORS EXPRESS GRANGER
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:
1831435924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7115 HERITAGE SQUARE DR
Provider Second Line Business Mailing Address:
SUITE 1250
Provider Business Mailing Address City Name:
GRANGER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46530-5639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-272-2000
Provider Business Mailing Address Fax Number:
574-272-3300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7115 HERITAGE SQUARE DR
Provider Second Line Business Practice Location Address:
SUITE 1250
Provider Business Practice Location Address City Name:
GRANGER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46530-5639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-272-2000
Provider Business Practice Location Address Fax Number:
574-272-3300
Provider Enumeration Date:
12/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTINO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
OWNER / PHYSICIAN
Authorized Official Telephone Number:
412-854-4351

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)