Provider Demographics
NPI:1972556702
Name:BOYNE COUNTRY URGENT CARE P.C.
Entity Type:Organization
Organization Name:BOYNE COUNTRY URGENT CARE P.C.
Other - Org Name:UP NORTH MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESTINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-3284
Mailing Address - Street 1:1951 S OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8489
Mailing Address - Country:US
Mailing Address - Phone:989-732-3284
Mailing Address - Fax:989-732-6395
Practice Address - Street 1:1951 S OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8489
Practice Address - Country:US
Practice Address - Phone:989-732-3284
Practice Address - Fax:989-732-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080B410910OtherBLUE CROSS BLUE SHIELD GR
MI0P16030Medicare ID - Type Unspecified