Basic Information
| Provider Information | |||||||||
| NPI: | 1801124516 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VAN BUREN URGENT CARE CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11650 BELLEVILLE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | VAN BUREN TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346999888 | ||||||||
| FaxNumber: | 7342931774 | ||||||||
| Practice Location | |||||||||
| Address1: | 11650 BELLEVILLE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | VAN BUREN TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346999888 | ||||||||
| FaxNumber: | 7342931774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2009 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | HURAIBI | ||||||||
| AuthorizedOfficialFirstName: | SAMEER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER MEDICAL DIRECTOR PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3135150024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M. D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 4301085918 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 740H267640 | 01 | MI | BC TRAD UC NETWORK | OTHER | 740H267640 | 01 | MI | BCN GROUP | OTHER |