1700036936 NPI number — OXFORD URGENT CARE P L C

Table of content: (NPI 1700036936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700036936 NPI number — OXFORD URGENT CARE P L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OXFORD URGENT CARE P L 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:
1700036936
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:
72 S WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48371-6421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-236-8333
Provider Business Mailing Address Fax Number:
248-236-8666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48371-6421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-236-8333
Provider Business Practice Location Address Fax Number:
248-236-8666
Provider Enumeration Date:
09/24/2008

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: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 700F379500 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1700036936 . This is a "BLUE CARE NETWORK OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 170036936 . This is a "COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1700036936 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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