1972556702 NPI number — BOYNE COUNTRY URGENT CARE P.C.

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 1972556702 NPI number — BOYNE COUNTRY URGENT CARE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOYNE COUNTRY URGENT CARE 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:
Provider Other Organization Name Type Code:
6
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:
1972556702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1951 S OTSEGO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAYLORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49735-8489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-732-3284
Provider Business Mailing Address Fax Number:
989-732-6395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1951 S OTSEGO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAYLORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49735-8489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-732-3284
Provider Business Practice Location Address Fax Number:
989-732-6395
Provider Enumeration Date:
05/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
DESTINEY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
989-732-3284

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080B410910 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".