Provider Demographics
NPI:1851344964
Name:URGENT CARE OF TRAVERSE CITY PLLC
Entity Type:Organization
Organization Name:URGENT CARE OF TRAVERSE CITY PLLC
Other - Org Name:WALK IN CLINIC OF TRAVERSE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPRINGSTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-929-1234
Mailing Address - Street 1:3074 N US 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4533
Mailing Address - Country:US
Mailing Address - Phone:231-929-1234
Mailing Address - Fax:231-935-0984
Practice Address - Street 1:3074 N US 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4533
Practice Address - Country:US
Practice Address - Phone:231-929-1234
Practice Address - Fax:231-935-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080B810330OtherBLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM
MI0B81033OtherBCBS OF MI GROUP #
MI1851344964OtherURGENT CARE OF TRAVERSE C
MI700B810660OtherBLUE CARE NETWORK
MI080B810330OtherBLUE CROSS BLUE SHIELD
MI080B810330OtherBLUE CARE NEWTWORK
MI1265438790Medicaid
MI1134124662Medicaid
MI0B81033OtherBLUE CARE NETWORK
MI0B81033OtherBLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM
MI1851344964OtherWALK IN CLINIC OF TRAVERS
MI0B81066OtherBLUE CARE NETWORK
MI1962408393Medicaid
MI1265438790Medicaid
MI1851344964OtherWALK IN CLINIC OF TRAVERS
MI1851344964OtherURGENT CARE OF TRAVERSE C
MI1962408393Medicaid