Provider Demographics
NPI:1770744773
Name:URGENT CARE CLINIC
Entity type:Organization
Organization Name:URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIDA
Authorized Official - Middle Name:SARNO
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-925-6600
Mailing Address - Street 1:1850 PIPESTONE RD
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-2304
Mailing Address - Country:US
Mailing Address - Phone:269-925-6600
Mailing Address - Fax:269-925-9528
Practice Address - Street 1:1850 PIPESTONE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2304
Practice Address - Country:US
Practice Address - Phone:269-925-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037695261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center