1861791998 NPI number — BRIGHTON URGENT CARE PC

Table of content: (NPI 1861791998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861791998 NPI number — BRIGHTON URGENT CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTON URGENT CARE PC
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:
1861791998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 GENOA BUSINESS PARK DR
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48114-7367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-844-0400
Provider Business Mailing Address Fax Number:
810-844-0804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 GENOA BUSINESS PARK DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48114-7367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-844-0400
Provider Business Practice Location Address Fax Number:
810-844-0804
Provider Enumeration Date:
03/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ARSIWALA
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
810-844-0400

Provider Taxonomy Codes

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

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

  • Identifier: 740D701450 . This is a "BC TRAD UC NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 740D701450 . This is a "BCN GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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