Provider Demographics
NPI:1790030385
Name:HOMETOWN URGENT CARE OF MICHIGAN, P.C.
Entity Type:Organization
Organization Name:HOMETOWN URGENT CARE OF MICHIGAN, P.C.
Other - Org Name:WELLNOW URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-699-9032
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0500
Mailing Address - Country:US
Mailing Address - Phone:716-699-9032
Mailing Address - Fax:
Practice Address - Street 1:6210 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-4019
Practice Address - Country:US
Practice Address - Phone:937-236-8630
Practice Address - Fax:937-236-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790030385Medicaid
MI6201Medicare PIN