Provider Demographics
NPI:1598129488
Name:SUPERIOR WALK-IN CENTER, PC
Entity Type:Organization
Organization Name:SUPERIOR WALK-IN CENTER, PC
Other - Org Name:SUPERIOR WALK-IN & FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-387-4220
Mailing Address - Street 1:1504 SANDPOINT RD
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1406
Mailing Address - Country:US
Mailing Address - Phone:906-387-4220
Mailing Address - Fax:906-387-5449
Practice Address - Street 1:2382 US HIGHWAY 41 W
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2456
Practice Address - Country:US
Practice Address - Phone:906-449-2005
Practice Address - Fax:906-449-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty