Basic Information
| Provider Information | |||||||||
| NPI: | 1861811382 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PETOSKEY URGENT CARE BILLING PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PETOSKEY URGENT CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1890 S US HIGHWAY 131 UNIT 4 | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314872000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1890 S US HIGHWAY 131 UNIT 4 | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497708344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314872000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2014 | ||||||||
| LastUpdateDate: | 10/17/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RACIGNOL | ||||||||
| AuthorizedOfficialFirstName: | CHRISTY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BILLING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2313482828 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUICK CARE FAMILY MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.