Provider Demographics
NPI:1821473935
Name:PREMIUM URGENT CARE, INC.
Entity Type:Organization
Organization Name:PREMIUM URGENT CARE, INC.
Other - Org Name:PREMIUM URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-797-4315
Mailing Address - Street 1:2021 HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6101
Mailing Address - Country:US
Mailing Address - Phone:559-797-4315
Mailing Address - Fax:559-321-8730
Practice Address - Street 1:6643 N. MILBURN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722
Practice Address - Country:US
Practice Address - Phone:559-797-4315
Practice Address - Fax:559-321-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83169YOtherBLUE SHIELD GROUP PIN
CACA109622Medicare PIN