Provider Demographics
NPI:1063159630
Name:MOUND URGENT CARE PLLC
Entity type:Organization
Organization Name:MOUND URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMASHKIEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-561-1291
Mailing Address - Street 1:31200 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4734
Mailing Address - Country:US
Mailing Address - Phone:248-850-8395
Mailing Address - Fax:248-850-8495
Practice Address - Street 1:31200 MOUND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4734
Practice Address - Country:US
Practice Address - Phone:248-850-8395
Practice Address - Fax:248-850-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care