Provider Demographics
NPI:1356518328
Name:CLARKSTON URGENT CARE PLC
Entity type:Organization
Organization Name:CLARKSTON URGENT CARE PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-625-2273
Mailing Address - Street 1:5701 BOW POINTE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3198
Mailing Address - Country:US
Mailing Address - Phone:248-625-2273
Mailing Address - Fax:248-625-6336
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3198
Practice Address - Country:US
Practice Address - Phone:248-625-2273
Practice Address - Fax:248-625-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015584261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI740F394110OtherBC TRAD UC NETWORK
MI740F394110OtherBCN GROUP