Provider Demographics
NPI:1104097625
Name:MEADOWBROOK URGENT CARE PC
Entity type:Organization
Organization Name:MEADOWBROOK URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-476-8500
Mailing Address - Street 1:25500 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1845
Mailing Address - Country:US
Mailing Address - Phone:248-476-8500
Mailing Address - Fax:248-543-3434
Practice Address - Street 1:37463 DUTTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3502
Practice Address - Country:US
Practice Address - Phone:225-313-3754
Practice Address - Fax:225-313-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH65468Medicare UPIN
MIM48310072Medicare PIN