Provider Demographics
NPI:1811273295
Name:PRN CLINIC URGENT CARE, PLLC
Entity type:Organization
Organization Name:PRN CLINIC URGENT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTHRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-493-4754
Mailing Address - Street 1:2110 N MORSON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3456
Mailing Address - Country:US
Mailing Address - Phone:989-401-7225
Mailing Address - Fax:989-401-7226
Practice Address - Street 1:2110 N MORSON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3456
Practice Address - Country:US
Practice Address - Phone:989-401-7225
Practice Address - Fax:989-401-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5252001OtherMEDICARE
MI1760693196Medicaid
MI1811273295Medicaid
MI9385074OtherAETNA / COFINITY
MI0130206OtherBCBSM