Basic Information
Provider Information
NPI: 1326070897
EntityType: 2
ReplacementNPI:  
OrganizationName: MIDMICHIGAN URGENT CARE
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3009 N SAGINAW RD
Address2:  
City: MIDLAND
State: MI
PostalCode: 486404555
CountryCode: US
TelephoneNumber: 9896331350
FaxNumber: 9896331355
Practice Location
Address1: 3009 N SAGINAW RD
Address2:  
City: MIDLAND
State: MI
PostalCode: 486404555
CountryCode: US
TelephoneNumber: 9896331350
FaxNumber: 9896331355
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 08/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DRIMALLA
AuthorizedOfficialFirstName: RICHARD
AuthorizedOfficialMiddleName: B
AuthorizedOfficialTitleorPosition: MEDICAL DIRECTOR
AuthorizedOfficialTelephone: 9896331350
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
166490905MI MEDICAID


Home