Provider Demographics
NPI:1063482966
Name:RIVER URGENT CARE & MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:RIVER URGENT CARE & MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-671-4900
Mailing Address - Street 1:3645 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2225
Mailing Address - Country:US
Mailing Address - Phone:734-671-4900
Mailing Address - Fax:734-671-4949
Practice Address - Street 1:3645 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2225
Practice Address - Country:US
Practice Address - Phone:734-671-4900
Practice Address - Fax:734-671-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052864146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108253031OtherBCBS PIN
MI4463280 10Medicaid
MI1108253031OtherBCBS PIN
MIF14242Medicare UPIN