Provider Demographics
NPI:1265130025
Name:PREMIUM URGENT CARE INC
Entity type:Organization
Organization Name:PREMIUM URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-236-1486
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:93611-6316
Mailing Address - Country:US
Mailing Address - Phone:559-387-5230
Mailing Address - Fax:559-321-8730
Practice Address - Street 1:1477 E SHAW AVE STE 150
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8023
Practice Address - Country:US
Practice Address - Phone:559-477-4495
Practice Address - Fax:559-321-8730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIUM URGENT CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care