Provider Demographics
NPI:1316018971
Name:ROCHESTER URGENT CARE, P.C.
Entity Type:Organization
Organization Name:ROCHESTER URGENT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:STAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-853-2009
Mailing Address - Street 1:215 E AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5260
Mailing Address - Country:US
Mailing Address - Phone:248-853-2009
Mailing Address - Fax:248-853-4105
Practice Address - Street 1:215 E AUBURN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5260
Practice Address - Country:US
Practice Address - Phone:248-853-2009
Practice Address - Fax:248-853-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235377052OtherBLUE CARE NETWORK OF MI
MIOM27740OtherHAP
MI700F313160OtherBCBS NUMBER
MI1316018971Medicaid
MI1316018971OtherCOMMERCIAL
MI1316018971OtherCOMMERCIAL