Provider Demographics
NPI:1912994336
Name:CENTRAL MICHIGAN URGENT CARE
Entity Type:Organization
Organization Name:CENTRAL MICHIGAN URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHABIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-772-9300
Mailing Address - Street 1:520 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1828
Mailing Address - Country:US
Mailing Address - Phone:989-772-9300
Mailing Address - Fax:989-773-0558
Practice Address - Street 1:520 N MISSION ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1828
Practice Address - Country:US
Practice Address - Phone:989-772-9300
Practice Address - Fax:989-773-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047556261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON16440Medicare ID - Type Unspecified
B49077Medicare UPIN