Provider Demographics
NPI:1740458033
Name:URGENT CARE EXPRESS PLLC
Entity type:Organization
Organization Name:URGENT CARE EXPRESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENYON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-317-0565
Mailing Address - Street 1:4950 E BLUE GRASS RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6020
Mailing Address - Country:US
Mailing Address - Phone:989-317-0565
Mailing Address - Fax:989-317-0567
Practice Address - Street 1:4950 E BLUE GRASS RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-6020
Practice Address - Country:US
Practice Address - Phone:989-317-0565
Practice Address - Fax:989-317-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061761261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C71073OtherBCBSM
MI0P59290Medicare PIN